Anesthesia, COPD, Ventilator Lung
Conditions
Brief summary
Patients with chronic obstructive pulmonary disease (COPD) have a significantly increased risk of postoperative pulmonary complications (PPC). Protective ventilation of the lungs could reduce the rate of PPC in patients with COPD. It has been suggested that flow controlled ventilation (FCV) may be less invasive and more protective to the lungs than conventional ventilation in patients with COPD. The primary aim of this study is to determine a optimal individual ventilation setting for FCV in ten participants with COPD.
Detailed description
The estimated worldwide chronic obstructive pulmonary disease (COPD) mean prevalence is 13.1%. In 2015, 3.2 million people died from COPD worldwide, and estimates show that COPD will be the third leading cause of death in 2030. Patients with COPD are at high risk for postoperative pulmonary complications (PPC). It has been proposed that FCV might be less-invasive and more protective for the lungs than conventional ventilation in patients with COPD. The pathophysiology of COPD is multifactorial, with the collapse of the central airways having a major impact on the symptoms. Minimizing the expiratory flow could prevent this airway pathology, and thus be beneficial in the ventilation of patients with COPD. In the operation theater participants will be ventilated with flow controlled ventilation (FCV). Arterial blood gas analysis and electrical impedance tomography (EIT) will be measured. The aim of the study is to determine the best end-expiratory pressure and driving pressure (assessed after anesthesia induction based on compliance and EIT parameters).
Interventions
None listed
Sponsors
Ventinova Medical, Eindhoven, Netherlands
Timple SA, Rua Simao Álvares 356 Conj. 41,42 e 51 - Pinheiros, Sao Paulo (Brasilien)
Universitätsklinikum Hamburg-Eppendorf
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients undergoing surgery with endotracheal intubation * Age ≥ 18 * Verified COPD (preoperative spirometry)
Exclusion criteria
* Pregnant woman * Laparoscopic surgery * Surgery that might interfere with EIT measurement * Cardiac Implantable Electronic Devices
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Best end-expiratory pressure | 1 hour after tracheal Intubation | Best end-expiratory pressure (mbar), defined as the end-expiratory pressure associated with the best compliance, best tradeoff between alveolar collapse and hyper distension (EIT) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Dissipated energy | 1 hour after tracheal intubation | Calculated dissipated energy per liter of gas ventilated (J) during ventilation. |
| Required minute volume to maintain carbon dioxide partial pressure (pCO2) level | 1 hour after tracheal intubation | The minute volume (L/min) of the ventilator will be adjusted to maintain the preoperative baseline pCO2 level (blood gas analysis). |
| Applied mechanical power | 1 hour after tracheal intubation | Calculated applied mechanical power during ventilation (J/min) |
| Ventilation distribution | 1 hour after tracheal intubation | Expressed as the percentage of total pulmonary ventilation through each of the regions-of-interest, total 100%. |
| Delta Z | 1 hour after tracheal intubation | Measured variation of impedance (arbitrary units) by electrical impedance tomography. |
| Delta end-expiratory lung impedance | 1 hour after tracheal intubation | Variation of impedance plethysmography at end-expiration measured by electrical impedance tomography. |
| Distribution of regional tidal ventilation | 1 hour after tracheal intubation | Distribution of regional tidal ventilation will be determined as the relation of regional ΔZ/total ΔZ (expressed in percentage), measured by electrical impedance tomography. |
| Regional lung compliance | 1 hour after tracheal intubation | Calculated by electrical impedance tomography (ml/cm H2O) |
| Center of Ventilation | 1 hour after tracheal intubation | Variations of the pulmonary ventilation distribution in the ventral-dorsal and left-right direction measured by electrical impedance tomography. |
| Global inhomogeneity index | 1 hour after tracheal intubation | Impedance variations of each pixel between the end of inspiration and expiration measured by electrical impedance tomography. |
| Best driving pressure | 1 hour after tracheal intubation | Best driving pressure (peek pressure - end-expiratory pressure in mbar) associated with the best compliance, best tradeoff between alveolar collapse and hyper distension (EIT) |
| carbon dioxide partial pressure (pCO2) | 1 hour after tracheal intubation | Measured by blood gas analysis (mmHg) |
| Horovitz quotient | 1 hour after tracheal intubation | Ratio of PaO2 (mmHg) and the fraction of oxygen of the inhaled air (FiO2). |
| Base excess | 1 hour after tracheal intubation | Measured by blood gas analysis (mmol/l) |
| potential of hydrogen (pH) | 1 hour after tracheal intubation | Measured by blood gas analysis |
| Resistance | 1 hour after tracheal intubation | Pressure change per flow change measured by the ventilator (kPa\*s/l). |
| tidal volume | 1 hour after tracheal intubation | Measure by ventilator (ml) |
| Peak inspiratory pressure | 1 hour after tracheal intubation | Maximum pressure during the inspiration measured by the ventilator (mbar). |
| Respiratory rate | 1 hour after tracheal intubation | Measured by the ventilator (1/min) |
| End-tidal carbon dioxide (etCO2) | 1 hour after tracheal intubation | End-tidal carbon dioxide level measured by the ventilator (mmHg). |
| arterial oxygen partial pressure (paO2) | 1 hour after tracheal intubation | Measured by blood gas analysis (mmHg) |
Countries
Germany
Outcome results
None listed