Obesity, Mechanical Ventilation Pressure High, Intraoperative Respiratory Injury
Conditions
Keywords
EIT, Obesity, Laparoscopy
Brief summary
This study will evaluate what is the impact of laparoscopy and Trendelenburg position on lung regional ventilation distribution in obese patients, focusing on the differences between the different phases of surgery.
Detailed description
Electrical impedance tomography (EIT) is a non invasive monitoring technique that allows to evaluate the regional distribution of ventilation. EIT has been used in different contexts, such as acute respiratory failure or intraoperative ventilation settings. Obesity, by increasing intrabdominal pressure, may reduce functional residual capacity after anesthesia and therefore require a more aggressive intraoperative ventilatory setting. In addition, laparoscopy, by increasing the volume of the abdomen, further pushes the diaphragm and increase the probability of lung collapse. The aim of the current study is to describe the effect of 1) anesthesia and of 2) laparoscopy and trendelenburg position on regional ventilation distribution. Moreover, the investigators will evaluate if the best ventilatory parameters set after anesthesia induction are confirmed also when the condition changes (i.e. during pneumoperitoneum and trendellenburg). Finally, the investigators will explore if the different parameters which can be provided by EIT agree in suggesting the best level of positive-end expiratory pressure in both moments of surgery.
Interventions
PROCEDUREPEEP titration trial
PEEP trial, starting from clinical PEEP 16 cmH2O and ending at PEEP 6 cmH2O. The PEEP trial will be stopped for haemodynamic instability (defined as arterial pressure \< 80 mmHg and /or heart rate \> 150 bpm) or desaturation (defined as SpO2 \< 92%).
Sponsors
Università degli Studi di Ferrara
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* age 18-90 years * Body mass index \> 30 kg/m2 * Major surgery * Predicted duration of surgery \> 2 hours * Predicted presence of invasive arterial pressure monitoring
Exclusion criteria
* emergency surgery * Refuse to participate from patient * presence of Implantable cardiac device or pacemaker * thoracic wounds * thoracic surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Best Positive end-expiratory pressure - Laparoscopy variability | Difference between the best PEEP after anesthesia induction and during pneumoperitoneum | The primary outcome will be the best PEEP found using the PEEP titration trial. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Best Positive end-expiratory pressure - EIT variability | After anesthesia induction, during pneumoperitoneum, end of surgery | Secondary outcome will be to compare the different values of best PEEP provided by several parameters of EIT to evaluate if the overlap. |
Countries
Italy
Contacts
Primary ContactSavino Spadaro, MD, PhD
Backup ContactGaetano Scaramuzzo, MD
Outcome results
None listed