Pulmonary Atelectasis, Postoperative
Conditions
Keywords
lung ultrasound, lung Atelectasis, Atelectasis, Pulmonary Atelectasis, pressure controlled ventilation - volume guarantee (PCV- VG), positive end-expiratory pressure (PEEP), lung recruitment maneuver, restrictive fluid strategies
Brief summary
the aim of this prospective randomized blinded clinical study will be to assess the ultrasound evaluation of different preventive measures of post operative lung atelectasis in abdominal surgeries; these measures include ventilation and fluid measures
Detailed description
ultrasound evaluation for application of different preventive measures of post operative lung atelectasis, including positive end-expiratory pressure, lung recruitment maneuvers, and restrictive fluid management.
Interventions
OTHERPEEP
Patients will be ventilated with PEEP of 8 cm H2O and fluid management: 500 ml of Ringer's lactate in the recovery room before surgery and Ringer's lactate at a rate of 4 mL/kg/hour from the beginning to the end of the surgery.
OTHERPEEP/RM
Patients will be ventilated with PEEP of 8 cm H2O, and then RM (30 cm H2O for 30 s) will be applied immediately after the second LUS examination and repeated every 30 minutes till emergence and fluid management: 500 ml of Ringer's lactate in recovery room before surgery and Ringer's lactate at a rate of 4 mL/kg/hour from the beginning to the end of the surgery
OTHERPEEP/RM/RF
Patients will be ventilated with PEEP of 8 cm H2O, and then RM (30 cm H2O for 30 s) will be applied immediately after the second LUS examination and repeated every 30 minutes till emergence and restrictive fluid management (RF). Ringer's lactate at a rate of 3 mL/kg/hour from the beginning to the end of the surgery
Sponsors
Al-Azhar University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Caregiver)
Intervention model description
The patients will be assigned into three equal groups of 20 patients each: 1. Group I: PEEP of 8 cm H2O and fluid management: 500 ml + 4 mL/kg/hour Ringer's lactate 2. Group II: PEEP/RM group, addition of RM (30 cm H2O for 30 s) 3. Group III: PEEP/RM group and restricted fluid management 3 mL/kg/hour Ringer's lactate A total sample size of 60 patients will be involved.
Eligibility
Sex/Gender
ALL
Age
30 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* ASA physical status I or II, of either gender. * BMI \< 40 * Age 30-60 years * scheduled for elective abdominal surgeries
Exclusion criteria
* Patient refusal * American Society of Anesthesiologists (ASA) physical status classification system more than II * BMI \> 40 . * Psychiatric disorders * History of chest disorders such as asthma and obstructive pulmonary disease (COPD). * History of Previous Thoracic Procedures. * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Lung ultrasound assessment of postoperative pulmonary atelectasis at the end of surgery | at the end of surgery before emergence from GA. | Lung ultrasound assessment of postoperative pulmonary atelectasis at the end of surgery. The Lung Ultrasound Score (LUS): the key points based on ultrasound findings: I. 0 points: (N) Normal aeration (presence of lung sliding with A-lines or \<2 separate B-lines). II. 1 point: (B1) Moderate loss of lung aeration (≥3 well-defined B lines). III. 2 points: (B2) Severe loss of lung aeration (coalescing B-lines). IV. 3 points: (C) Complete loss of lung aeration (pulmonary consolidations). Total Score: points will be distributed according to the worst ultrasound pattern observed: N = 0, B1 lines = 1, B2 lines = 2, C = 3. The LUS score ranging between 0 and 36 was calculated as the sum of points. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Lung ultrasound assessment | before induction of general anesthesia | Lung ultrasound assessment of atelectasis |
| arterial blood gases | 5 minutes post induction of general anesthesia | Pao2, spo2, paco2, pao2/fio2 |
Countries
Egypt
Outcome results
None listed