Lung Cancer
Conditions
Brief summary
Aim: End tidal carbondioxide pressure (EtCO2) is an indirect indicator of cardiac output (CO) which is monitored in every patient at perioperative setting. The investigators aimed to use increase of EtCO2 as a response to passive leg raising maneuver (PLR) to indicate fluid responsiveness in patients who underwent lung resection with video-assisted thoracoscopic surgery (VATS).
Detailed description
Materials and Methods: 50 patients included who are eligible according to inclusion criteria of the study who underwent lung resection operation via VATS between Agust 2020-March 2021. After a standardized anesthesia induction protocol and intubation, PLR is applied to all patients as soon as anesthesia depth and ventilation stabilized. An increase of 2 mmHg at EtCO2 at first minute of PLR evaluated as fluid responsive due to an increase of venous return. Responsive patients divided into two groups as study and control when unresponsive patiens inclueded into unresponsive group. Patients at study group received a fluid bolus (250 ml (and an additional 250 ml if mean arterial pressure remained below 65 mmHg )) in addition to maintainence fluid as control group and unresponsive group received only maintainence fluid. Hemodynamic data, surgery duration, total iv fluid administration, use of blood products, bleeding and urine output during surgery of all patients recorded. Preopretive and postoperative urea, creatinine and lactate levels of all patiens compared. Total iv fluid administration and urine output recorded during postoperative 24 hours.
Interventions
OTHER250 ml crystalloid bolus infusion
In thoracic surgical setting, restrictive fluid replacement is widely accepted. However, goal directed fluid therapies can provide a more precise and tailored fluid replacement for each patient. Although ERAS protocols emphasize otherwise, patients still arrive in the operating room with certain deficite, due to prolonged fasting or advanced age. PLR is used as a reversible fluid challenge since the blood which is pooled in the lower extremities as well as splancnic area. End tidal carbon dioxide is monitorized at each patient per American Society of Anesthesia Guideline. In this study, we aimed to assess the feasibility of end tidal carbondioxide changes as a response to passive leg raise maneuer (PLR) for preload optimization in thoracic surgical practice.
Sponsors
Istanbul University - Cerrahpasa
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients undergoing lung resection surgery via VATS * ASA I-II-III * Patients older than 18 years
Exclusion criteria
* ASA IV or more * Post operative ICU stay * Resections greater than lobectomy * History of renal and heart failure * Patients younger than 18 years.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in End-Tidal Carbon Dioxide (EtCO₂) in Response to Passive Leg Raise (PLR) | Time Frame: Intraoperative (Baseline and 1 Minute After PLR) | Measurement Method: EtCO₂ (mmHg) will be recorded using a side-stream capnograph integrated into the anesthesia workstation. Baseline EtCO₂ will be measured in the supine position before the PLR maneuver. The PLR maneuver will then be performed by elevating the lower extremities to a 45-degree angle while maintaining a supine upper body position. The position remained for 1 minute and the maximum level of EtCO₂recorded. Outcome Definition: A ≥2 mmHg increase in EtCO₂ from baseline within 1 minute of PLR will be classified as a positive response, indicating fluid responsiveness. Patients with an EtCO₂ increase of \<2 mmHg will be classified as non-responders. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Serum Urea Levels | Preoperative, 24 hours, and 48 hours postoperatively (if patient remains hospitalized) | Blood samples will be collected at baseline (preoperative), and at 24 hours postoperatively for all participants. If the patient remains hospitalized at 48 hours, an additional blood sample for urea will be collected. Serum urea (mg/dL) levels will be analyzed using standard laboratory biochemical methods. |
| Change in Serum Creatinine Levels | Preoperative, 24 hours, and 48 hours postoperatively (if patient remains hospitalized) | Blood samples will be collected at baseline (preoperative), and at 24 hours postoperatively for all participants. If the patient remains hospitalized at 48 hours, an additional blood sample for creatinine will be collected. Serum creatinine (mg/dL) levels will be analyzed using standard laboratory biochemical methods. |
| Change in Serum Lactate Levels | Preoperative, 24 hours | Blood samples will be collected at baseline (preoperative), and at 24 hours postoperatively for all participants. Serum lactate (mmol/L) levels will be analyzed using standard laboratory biochemical methods. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Correlation Between Pleth Variability Index (PVI) and Fluid Responsiveness Based on EtCO₂ Changes | Time Frame: Intraoperative (Baseline and during 1 Minute of PLR maneuer) | PVI (%) will be recorded before and after PLR using Masimo Rainbow SET. Correlation between PVI values and EtCO₂-based fluid responsiveness classification (≥2 mmHg EtCO₂ increase) will be analyzed. |
Countries
Turkey (Türkiye)
Outcome results
None listed