Anesthesia, Surgery
Conditions
Keywords
prone position, anesthesia, general, end-expiratory pressure, positive, respiration, artificial
Brief summary
Background: There is a lack of studies regarding Optimal (best) positive end-expiratory pressure (PEEP) in prone position during surgery, and its relation with optimal PEEP in supine position. Hypothesis: In patients undergoing scheduled spinal surgery, optimal PEEP in the prone position is lower than optimal PEEP in the supine position. Aims: To assess the difference optimal PEEP in supine vs. prone positions in patients undergoing spine surgery. To evaluate the changes in optimal PEEP in prone position throughout the surgical procedure. Methods: Observational study, one center. Main variable: optimal PEEP. Secondary variables: PaO2, pCO2 and dynamic compliance (Crd) in prone and supine position.
Detailed description
Recruitment: Patients scheduled for spine surgery were Main outcome: Optimal PEEP determined after a pulmonary recruitment manoeuvre in supine and in prone position and every hour during the surgery in prone position. Secondary outcomes: Pulmonary compliance, blood gas analysis and hemodynamic parameters
Interventions
OTHEREvaluation of PEEP in prone position
Assessment of optimal Positive End-Expiratory Pressure (PEEP) in patients undergoing scheduled spine surgery in prone position.
Sponsors
Parc de Salut Mar
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥18 years. * Spine prone surgery lasting ≥2 hours. * Absence of known pulmonary pathology.
Exclusion criteria
* Pregnancy or lactation. * Contraindication to alveolar recruitment maneuvers (risk of barotrauma, hemodynamic instability). * Body mass index (BMI) \>35. * Heart failure defined as IC \<2.5 L/min/m2 and/or inotropic support requirements prior to surgery. * Diagnosis or suspicion of intracranial hypertension (intracranial pressure \>15 mmHg).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Positive End-Expiratory Pressure (PEEP) | 10 minutes after intubation | Positive End-Expiratory Pressure (cmH2O) in supine position |
| Change in Positive End-Expiratory Pressure (PEEP) | From determination of optimal PEEP until the first hour and then every hour, assessed up to the end of surgery (maximum 6 hours) | Variation of Positive End-Expiratory Pressure (cmH2O) during surgery in prone position with respect to PEEP value at 10 minutes after positioning |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Arterial oxygen pressure (PaO2) | 10 minutes after intubation | Partial pressure of oxygen (mmHg) in supine position |
| Change in arterial oxygen pressure (PaO2) | Measured at the same time as Auto PEEP until the first hour and then every hour, assessed up to the end of surgery (maximum 6 hours) | Variation of partial pressure of oxygen (mmHg) during surgery in prone position |
| Static compliance | 10 minutes after intubation | Tidal volume / Plateau pressure ratio (mL/cmH2O) in supine position |
| Change in arterial carbon dioxide pressure (PaCO2) | Measured at the same time as Auto PEEP until the first hour and then every hour, assessed up to the end of surgery (maximum 6 hours) | Variation of partial pressure of carbon dioxide (mmHg) during surgery in prone position |
| Arterial carbon dioxide pressure (PaCO2) | 10 minutes after intubation | Partial pressure of carbon dioxide (mmHg) in supine position |
| Change in static compliance | Measured at the same time as Auto PEEP until the first hour and then every hour, assessed up to the end of surgery (maximum 6 hours) | Variation of static compliance (Tidal volume / Plateau pressure ratio, in mL/cmH2O) during surgery in prone position |
Countries
Spain
Outcome results
None listed