Postoperative Atelectasis, Ventilator Lung, Atelectasis, Recruitment
Conditions
Brief summary
During laparoscopic surgery, gas infiltration and head down position cause pulmonary atelectasis. Alveolar recruitment maneuvers are beneficial in reopening collapsed alveoli and improving lung mechanics. Ventilator-driven Alveolar recruitment maneuvers may restore lung volume but it remains unknown which method is most effective. The primary aim was to compare the efficacy of two ventilator-driven ARMs method using incremental tidal volume or positive end expiratory pressure(PEEP) until plateau pressure 30 cmH20 (within driving pressure 20 cmH20).
Detailed description
General anesthesia promotes the formation of atelectasis, which negatively impacts respiratory function and may be associated with subsequent pulmonary complications. Especially, during laparoscopic surgery, gas infiltration and head down position cause pulmonary atelectasis. Alveolar recruitment maneuvers are beneficial in reopening collapsed alveoli and improving lung mechanics, suggesting that performing an Alveolar recruitment maneuvers after intubation, circuit disconnection, position change, intraabdominal gas infiltration. Conventional manual ARM is performed by sustained lung inflation using the reservoir bag on the anaesthesia machine with the adjustable pressure-limiting valve set to the desired inflation pressure. However, the manual ARM can lead to brief loss of positive pressure when switching back to the ventilator circuit, which results in re-collapse of alveoli. For this reason, investigators try to compare the methods of the ventilator-driven ARM.
Interventions
The two methods for performing an alveolar recruitment maneuver. Alveolar recruitment maneuvers consisted of a stepwise increase in tidal volume to a plateau pressure of 30 cm H2O versus a stepwise increase in PEEP H2O to a plateau pressure of 30 cm H2O.
Sponsors
Samsung Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* patients who receive laparoscopic surgery in trendelenberg position
Exclusion criteria
* Patients who are simultaneously participating in other studies * Patients who are scheduled to leave the intensive care unit after surgery * Patients with obstructive or restrictive pattern of Severe or moderate grade on Pulmonary function test * High risk in cardiovascular events (expected postoperative cardiovascular event \> 5%) * Patients with emphysema confirmed by imaging test * patients with obesity BMI \> 35 kg / m2
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| the change of Atelectasis volume | intraoperative time point of intubation, pneumoperitoneum and trendelenberg position, end of surgery | electrical impedance tomography monitoring: end-expiratory lung impedance, atelectasis (%) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| the change of lung compliance value | intraoperative time point of intubation, pneumoperitoneum and trendelenberg position, end of surgery | comparison of lung compliance mL/cmH2O (static compliance=tidal volume/driving pressure) before/after recruitment maneuver |
| the change of arterial blood gas analysis | intraoperative time point of intubation, pneumoperitoneum and trendelenberg position, end of surgery | comparison of PaO2/fraction of inspired oxygen (FiO2) mmHg before/after recruitment maneuver |
| the change of driving pressure value | intraoperative time point of intubation, pneumoperitoneum and trendelenberg position, end of surgery | comparison of driving pressure cmH2O (plateau pressure-positive end expiratory pressure) before/after recruitment maneuver |
| the change of peak pressure value | intraoperative time point of intubation, pneumoperitoneum and trendelenberg position, end of surgery | comparison peak pressure (cmH2O) before/after recruitment maneuver |
| The difference of atelectasis | at postoperative 30 minutes | atelectasis score by lung ultrasonography (score range 0\ 36) |
Countries
South Korea
Outcome results
None listed