Pulmonary Atelectasis, Postoperative
Conditions
Keywords
robot-assisted surgery, prostatectomy, laparoscopy, positive end-expiratory pressure, individualized, atelectasis, general anesthesia
Brief summary
During robot-assisted radical prostatectomy, pneumoperitoneum with Trendelenburg position is used. However, perioperative atelectasis and respiratory complications may occur with high incidence due to general anesthesia and carbon dioxide pneumoperitoneum. Intraoperative ventilatory strategy to address these issues include intraoperative recruitment maneuver and positive end-expiratory pressure (PEEP). Recently, individualized optimal PEEP with minimal driving pressure or maximal respiratory compliance was reported to reduce respiratory complications after general anesthesia. A recent version of general anesthesia ventilator provides a stepwise procedure of determining optimal PEEP by calculating respiratory compliance. We investigated whether the application of individualized optimal PEEP could reduce the incidence of atelectasis and respiratory complications after robot-assisted laparoscopic radical prostatectomy compared to uniform PEEP.
Detailed description
During robot-assisted radical prostatectomy, pneumoperitoneum with Trendelenburg position is used. However, perioperative atelectasis and respiratory complications may occur with high incidence due to general anesthesia and carbon dioxide pneumoperitoneum. Intraoperative ventilatory strategy to address these issues include intraoperative recruitment maneuver and positive end-expiratory pressure (PEEP). Recently, individualized optimal PEEP with minimal driving pressure or maximal respiratory compliance was reported to reduce respiratory complications after general anesthesia. A recent version of general anesthesia ventilator provides a stepwise procedure of determining optimal PEEP by calculating respiratory compliance. We investigated whether the application of individualized optimal PEEP could reduce the incidence of atelectasis and respiratory complications after robot-assisted laparoscopic radical prostatectomy compared to uniform PEEP. We plan to determine the degree of immediate postoperative atelectasis by measuring the lung ultrasound score and compare the lung ultrasound score between groups.
Interventions
PROCEDUREIndividualized optimal positive end-expiratory pressure
Optimal PEEP will be determined by the automated procedure of step-wised decrease in the amount of PEEP of the anesthesia ventilator Aisys Care Station (GE Healthcare, Madison, Wisconsin, USA).
PROCEDUREConventional positive end-expiratory pressure
A same amount of PEEP of 7 centimeter hydrogen dioxide will be provided during the laparoscopic period of surgery.
Sponsors
Seoul National University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Masking description
Anesthesia care-provider cannot be blinded. Surgeon and outcome assessor will be blinded to the group assignment.
Intervention model description
Randomized controlled superiority trial with two arms of intervention.
Eligibility
Sex/Gender
MALE
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients undergoing robot-assisted laparoscopic radical prostatectomy * Patients receiving mechanical ventilation by Aisys Care Station anesthesia ventilator * Patients who provided written informed consent to participate in this clinical trial
Exclusion criteria
* American Society of Anesthesiologists physical status classification class 3 or more * Moderate or more obstructive or restrictive pulmonary disease * Preoperative adult respiratory distress syndrome or previous history of adult respiratory distress syndrome * history of heart failure, unstable angina, increased intracranial pressure * history of pneumothorax or presence of bullae
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Difference in lung ultrasound score | 10 min after surgery | Difference in postoperative lung ultrasound score and baseline lung ultrasound score |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Composite of respiratory complication | during postoperative seven days. | summation of the following events: hypoxemia (pulse oximetry of 95% or less), laryngospasm, bronchospasm, pneumonia, pulmonary infiltration, aspiration pneumonia, pneumonia), pulmonary infiltration, aspiration pneumonia, development of acute respiratory distress syndrome, atelectasis, pleural effusion, pulmonary edema, pneumothorax. |
| Length of hospital stay | during the postoperative one month | Length of total hospital stay |
| Postoperative Lung ultrasound score | 10 min after the end of anesthesia | A scoring system with a sum of the B-line score and consolidation score by lung ultrasound examination |
| Length of intensive care unit stay | during the postoperative one month | Length of total hospital stay |
| Baseline lung ultrasound score | 10 min before the start of anesthesia induction | A scoring system with a sum of the B-line score and consolidation score by lung ultrasound examination |
| Surgical wound dehiscence | during the postoperative one month | The rate of surgical wound dehiscence |
| Incidence of acute kidney injury | during the postoperative one month | Incidence of postoperative acute kidney injury |
| Incidence of surgical re-intervention | during the postoperative one month | Incidence of surgical re-open |
| Surgical wound infection | during the postoperative one month | The rate of surgical wound infection |
Countries
South Korea
Outcome results
None listed