Lung Cancer (Including Metastatic Cancer), Pulmonary Infection
Conditions
Brief summary
One lung ventilation (OLV) is essential during thoracic surgery. During OLV, intrapulmonary shunt can be increased resulting hypoxemia. Although OLV technique had been advanced so far, hypoxemia during OLV reaches about 10% in spite of inspired oxygen fraction 100%. Iloprost is a prostaglandin analogue used for pulmonary hypertension, which can decrease pulmonary artery resistance by selectively dilating pulmonary artery. In this prospective, randomized, double blind study, the investigator is planning to investigate the effects of iloprost on respiratory physiology (intrapulmonary shunt, deadspace, oxygenation, etc) in obese patients.
Interventions
DRUGnormal saline inhalation
When anesthesia induction finishes, change patients' position from supine to lateral position and measure ABGA, VBGA while two lung is ventilated (T0). After 20 minutes of applying one-lung ventilation, measure ABGA and VBGA (T1). Apply normal saline inhalation for control group and measure ABGA at the time of 20 min after normal saline inhalation has finished (T2).
When anesthesia induction finishes, change patients' position from supine to lateral position and measure ABGA, VBGA while two lung is ventilated (T0). After 20 minutes of applying one-lung ventilation, measure ABGA and VBGA (T1). Apply iloprost inhalation for iloprost group and measure ABGA at the time of 20 min after iloprost inhalation has finished (T2).
Sponsors
Yonsei University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
40 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. scheduled for VATS lobectomy 2. 40 \< age \< 80 3. American Society of Anaesthesiologists(ASA) physical status classification I\ III 4. BMI \> 30 kg /m2
Exclusion criteria
1. American Society of Anaesthesiologists(ASA) physical status classification IV or more 2. NYHA class III\ IV 3. Severe obstructive lung disease and/or restrictive lung disease patients 4. patients with end-organ diseases (i.e. heart failure, respiratory failure, hepatic failure, renal failure) 5. arrhythmia 6. pregnant women 7. pulmonary edema or pulmonary arterial hypertension 8. cerebrovascular disease 9. unstable angina or myocardial infarction within 6 months 10. patients with allergic reaction at iloprost
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Result of arterial blood gas analysis : partial pressure of oxygen(PaO2) | 20 minutes after iloprost inhalation (T2) |
| Result of arterial blood gas analysis : partial pressure of oxygen in the arterial blood(PaO2)/Fraction of inspired oxygen(FiO2) ratio (P/F ratio) | 20 minutes after iloprost inhalation (T2) |
| Result of arterial blood gas analysis : Oxygen saturation in arterial blood(SaO2) | 20 minutes after iloprost inhalation (T2) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| deadspace | 20 minutes after iloprost inhalation (T2) | Dead space ventilation was calculated with Paco2 and end-tidal carbon dioxide (Etco2) according to the Hardman and Aitkenhead equation \[1.14 × (Paco2- Etco2)/Paco2 - 0.005\]. |
| intrapulmonary shunt | 20 minutes after iloprost inhalation (T2) | -Shunt fraction (Qs/Qt) was calculated using the following formula: Qs/Qt = (CcO2-CaO2)/(CcO2-CvO2), (1) -whereby: * CaO2 = (PaO2 x 0.0031) + (Hemoglobin x 1.36 x SaO2), (2) * CvO2 = (PvO2 x 0.0031) + (Hemoglobin x 1.36 x SvO2), (3) * CcO2 = (\[FiO2 x (PB - PH2O) - PaCO2/Respiratory quotient\] x 0.0031) + (Hemoglobin x 1.36), (4) * PB is the barometric pressure (760 mmHg), the PH2O is 47 mmHg |
Countries
South Korea
Outcome results
None listed