Postoperative Atelectasis
Conditions
Keywords
lung protective ventilation strategy, individualized positive end-expiratory pressure, Laparoscopic bariatric surgery, Mechanical ventilation, Anesthetic management, Lung dynamic compliance, Postoperative Atelectasis
Brief summary
This study intends to explore the effect of dynamic compliance guided individualized positive end-expiratory pressure titration strategy on reducing the level of postoperative atelectasis in obese patient who have laparoscopic bariatric surgery.The results of the study are to assess the effects of this intervention on the incidence，duration of postoperative atelectasis and other complications including hypoxemia etc. after laparoscopic bariatric surgery.And reducing the burden of postoperative atelectasis on patients and their families, hospitals and public resources.
Interventions
PROCEDUREDynamic compliance guided individualized positive end-expiratory pressure titration strategy
Basic ventilation: Volume-controlled ventilation (VCV) mode with positive end-expiratory pressure (PEEP) of 8cm H2O after induction of anesthesia， Recruitment maneuver (RM): Pressure-controlled ventilation (PCV) mode increasing PEEP from 10 to 25cmH2O in step of 5cmH2O per 30s. PEEP-titration maneuver: ventilation parameters reset as basic ventilation with PEEP still 25cmH2O.Decrease PEEP to 5cmH2O in step of 2cmH2O per 10 respiratory cycles to confirm the highest dynamic lung compliance (Cdy). After titration: A new RM will be performed and the final PEEP will be the one related to highest Cdy plus 2cm H2O. Randomized after the second RM. Individualized PEEP arm: maintain individualized PEEP; PEEP8 arm: maintain a fixed PEEP of 8cm H2O. VCV with other ventilation parameters the same as basic ventilation until extubation . After discharged from postoperative anesthesia care unit (60 to 90 minutes after extubation): chest CT .
Sponsors
Xuzhou Medical University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Bmi ≥ 35 kg/ m2 2. over 18 years old 3. elective laparoscopic bariatric surgery (gastric bypass or sleeve)
Exclusion criteria
1. ASA \>IV 2. Lung bullae 3. thoracic surgery history 4. quit smoking less than 1 week 5. chronic obstructive pulmonary disease requiring oxygen 6. congestive heart failure (New York Heart Association classification ≥ III) 7. planned to be transferred to intensive care unit after surgery 8. Patients participating in another interventional study 9. Refuse to sign the informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of postoperative atelectasis | 60-90 minutes after extubation | The amount of postoperative atelectasis, expressed as the percentage of lung tissue in CT. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| PaO2/FiO2 ratio | 1 day before surgery(baseline)，5 minutes after anesthesia induction，1 hour after pneumoperitoneum，before extubation，30 minutes after extubation | PaO2/FiO2 ratio |
| Quality of Recovery Score - 40 (QoR-40) | 1 day before surgery(baseline)，1，2，7，30 days after surgery | Quality of recovery will be evaluated by Quality of Recovery 40 (QoR40),which assesses five dimensions of recovery (physical comfort,emotional state, physical independence , physiological support and pain ). Each item is rated on a five-point Likert scale: none of the time, some of the time, usually, most of the time, and all the time. The total score on the QoR40 ranges from 40 (poorest quality of recovery) to 200 (best quality of recovery). |
| Mini-Mental score examination (MMSE) | 1 day before surgery(baseline)，1，2 days after surgery | Mini-Mental score examination \[MMSE\] used for screening of dementia.The total score on the MMSE ranges from 0 (most severe dementia) to 24 (no dementia). |
| Postoperative Complication | 1，2，7 days after surgery | including pulmonary and other systematic postoperative complications |
| Mean arterial pressure | every 5minutes During Surgery；end of each step during RM and titration strategy | Mean arterial pressure = (systolic blood pressure + 2 × diastolic blood pressure) / 3（mmHg） |
| pulse oxygen | 24 hours after surgery | Continuous measurement of 24h pulse oxygen after surgery（%） |
| diastolic blood pressure | every 5minutes During Surgery；end of each step during RM and titration strategy | diastolic blood pressure measured by invasive arterial blood pressure（mmHg） |
| heart rate | every 5minutes During Surgery；end of each step during RM and titration strategy | heart rate per minute |
| dynamic compliance | every 5minutes During Surgery；end of each step during RM and titration strategy | tidal volume/(airway peak pressure - PEEP)（ml/cmH2O） |
| airway plateau pressure | every 5minutes During Surgery；end of each step during RM and titration strategy | airway plateau pressure is directly showed in the screen of ventilator（cmH2O） |
| airway peak pressure | every 5minutes During Surgery；end of each step during RM and titration strategy | airway peak pressure is directly showed in the screen of ventilator（cmH2O） |
| systolic blood pressure | every 5minutes During Surgery；end of each step during RM and titration strategy | systolic blood pressure measured by invasive arterial blood pressure（mmHg） |
Countries
China
Outcome results
None listed