Lung Ultrasound, Positive End Expiratory Pressure, Prostate Cancer, Surgery, Urinary Bladder Cancer
Conditions
Keywords
Radical Cystectomy, Radical Prostatectomy, Robotic, Anesthesia, Lung-Ultrasound, Positive End Expiratory Pressure
Brief summary
There is an increasing trend in the use of robotic-assisted radical prostatectomy or cystectomy (RARPC). Preventing lung atelectasis without inducing overdistention of the lung is challenging. Many studies tried to optimize PEEP titration by using methods such as dead space fraction guided and static pulmonary compliance directed techniques, or by using electrical impedance tomography. However, the use of these methods is limited by inaccuracy and the need for sophisticated devices. Bedside Lung ultrasound is fast, easy and economic technique that is gaining interest in the operating room. Ultrasound-guided PEEP titration has been used in bariatric surgeries (different position and usually shorter procedure time) and proved effective in improving oxygenation, compliance and reducing the incidence of postoperative pulmonary atelectasis and hypoxia without causing hemodynamic instability. The aim of this study is to evaluate the effectiveness of intraoperative individualized lung ultrasound-guided stepwise PEEP optimization in patients undergoing RARPC on oxygenation, intraoperative and early postoperative pulmonary complications.
Interventions
PROCEDURELung Ultrasound - guided Stepwise PEEP
After endo-tracheal intubation; A PEEP of 4 cmH2O will be initially used till 5 min after pneumoperitoneum. Then The PEEP will be adjusted in a stepwise approach after performing bedside lung ultrasound. The PEEP will be increased by 2 cmH2O until no lung collapse is detected. Lung ultrasound will be repeated 5 min after every change in the PEEP with a maximal PEEP of 12 cmH2O.
PROCEDUREStandard Ventilation Protocol
Volume-controlled ventilation (VCV) mode; with a tidal volume of 6 mL/kg of ideal weight, inspiratory : expiratory ratio 1: 2, PEEP 4 cmH2O, respiratory rate adjusted to keep end-tidal carbon dioxide tension (EtCO2) between 35 and 40 mm Hg, and inspired oxygen fraction of 50%.
Sponsors
Nazmy Edward Seif
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* ASA I, II \& III. * Normal respiratory functions or mild lung disease.
Exclusion criteria
* BMI more than 40. * Moderate to severe obstructive pulmonary disease (FEV1 \< 80% of predicted). * Moderate to severe restrictive pulmonary disease (TLC \< 70% of predicted). * Severe pulmonary hypertension (mean PAP\>55). * Previous lung surgery. * Decompensated cardiac disease (NYHA 3 or 4). * Patients who received invasive mechanical ventilation within the last 30 days before surgery.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Post-operative lung consolidation | 24 hours | Presence (or not) of post-operative lung consolidation detected by lung ultrasound. |
Countries
Egypt
Contacts
STUDY_CHAIRAshgan R Ali, MD
Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University
PRINCIPAL_INVESTIGATORNazmy S Mikhael, MD
Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University
STUDY_DIRECTORMustafa E Mohamed, MD
Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University
Outcome results
None listed