Thoracic Anesthesia, Thoracotomy Surgery
Conditions
Keywords
one lung ventilation, mechanical power, postoperative pulmonary complications
Brief summary
Thoracic surgery usually necessitates one-lung ventilation (OLV) to provide surgical access while maintaining adequate gas exchange. However, OLV is associated with an increased risk of PPCs , a major cause of morbidity and mortality. Mechanical power, a composite parameter incorporating tidal volume, respiratory rate, driving pressure, and flow resistance, has been proposed as a key factor influencing ventilator-induced lung injury (VILI) and postoperative outcome. Understanding the association between mechanical power during OLV and PPCs could provide insights for optimizing intraoperative ventilatory strategies and reducing the burden of PPCs. As OLV inherently alters normal lung mechanics by decreasing functional residual capacity and introducing inequalities in ventilation-perfusion ratio, the complexity of managing mechanical power becomes even more pronounced. Under these altered conditions, the risk of PPC-including atelectasis, pneumonia, and respiratory failure-can be significantly elevated. Factors such as ventilatory settings, lung protection strategies, and the duration of OLV play pivotal roles in influencing mechanical power delivery and thereby impacting lung function recovery post-surgery. Current literature indicates a correlation between inappropriate mechanical ventilation strategies during OLV and increased incidence of PPCs. However, there remains a gap in understanding how precisely mechanical power, as a quantifiable measure, influences patient outcomes following OLV. Therefore, this study aims to investigate the relationship between mechanical power during OLV and the subsequent risk of PPC. By elucidating these dynamics, the findings may inform clinical practices surrounding OLV management, ultimately improving patient safety and outcomes in thoracic surgery.
Interventions
None listed
Sponsors
Ankara University
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Patients aged 18 years or older, 2. ASA physical status I-IV 3. All thoracic surgeries 4. One lung ventilation period \>1 hour 5. Patients capable of giving written informed consent
Exclusion criteria
1-Patients undergoing cardiac surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of PPCs during the first five postoperative days, defined according to standard criteria | From enrollment to the end of postoperative 5 th day | Postoperative pulmonary complications ;(e.g., pneumonia, acute respiratory distress syndrome \[ARDS\], or prolonged mechanical ventilation).According to StEP-COMPAC group definition \[Abbott et al. 2018 Br J Anaesth 2018 May;120(5):1066-1079.\] |
Secondary
| Measure | Time frame |
|---|---|
| Threshold mechanical power (J/min)associated with PPCs | From enrollment to postoperative 5 th day |
| Unscheduled ICU admission rates | From enrollment to postoperative 5 th day |
| Extra-pulmonary postoperative complications(number of complications) | From enrollment to postoperative 5 th day |
| Length of ICU stay(day) | up to 5 th day |
| Length of hospital stay(day) | From enrollment to postoperative 5 th day |
Contacts
CONTACTCIGDEM YILDIRIM GUCLU, Prof Dr
Outcome results
None listed