Atelectasis
Conditions
Keywords
Positive End-Expiratory Pressure, Driving Pressure, Lung Ultrasound, Laparoscopy, Gynecologic Surgical Procedures
Brief summary
The purpose of this study is to compare two different airway pressure (PEEP) strategies during gynecological laparoscopic surgery to see which one better prevents lung collapse (atelectasis). We will compare a 'standard' fixed pressure with a 'personalized' pressure adjusted according to the patient's own lung mechanics (driving pressure). We will use lung ultrasound to check the lungs before surgery, 1 hour after surgery, and 24 hours after surgery to evaluate the results.
Detailed description
In this prospective observational study, we investigate the impact of PEEP strategies on lung collapse (atelectasis) in patients undergoing gynecological laparoscopy. The Standard Group receives a routine clinical application of 5 cmH2O PEEP. The Individualized Group undergoes a PEEP titration protocol where PEEP starts at 20 cmH2O and is adjusted to reach the optimal level based on the lowest driving pressure. To measure the results, a 12-zone Lung Ultrasonography (LUS) scoring system (0-3 points per zone) is utilized. Evaluations are conducted preoperatively (baseline), 1 hour postoperatively (early phase), and 24 hours postoperatively (late phase) to track the development and resolution of atelectasis.
Interventions
None listed
Sponsors
Ankara Etlik City Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Female patients aged between 18 and 65 years. * American Society of Anesthesiologists (ASA) physical status I, II, or III. * Scheduled for elective laparoscopic gynecological surgery (e.g., hysterectomy, myomectomy, sacrocolpopexy). * Planned to undergo general anesthesia with endotracheal intubation. * Expected surgery duration of 2 hours or more. * Body Mass Index (BMI) ≤ 35 kg/m².
Exclusion criteria
* History of moderate-to-severe Chronic Obstructive Pulmonary Disease (COPD), clinically significant interstitial lung disease, or severe restrictive lung disease. * New York Heart Association (NYHA) class III-IV heart failure, Ejection Fraction (EF) \< 35%, or severe valvular disease. * Advanced arrhythmia or hemodynamic instability (requiring high-dose vasopressor support). * History of respiratory failure requiring mechanical ventilation within the past 4 weeks. * Clinically or radiologically confirmed lower respiratory tract infection (e.g., pneumonia) within the past 1 month. * Presence of thoracic deformity, large surgical dressings, severe subcutaneous emphysema, or any condition that hinders lung ultrasound evaluation. * Pre-existing significant atelectasis or lung consolidation (defined as a score of 3 for consolidation or ≥2 zones with a score of ≥2 on preoperative LUS). * Expected inability to perform the 24-hour postoperative ultrasound measurement (e.g., due to early discharge).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Lung Ultrasonography (LUS) Score | Preoperatively (baseline), 1 hour postoperatively, and 24 hours postoperatively. | Atelectasis severity is assessed using a 12-zone Lung Ultrasonography (LUS) scoring system. Each zone is scored from 0 to 3 (0=normal aeration, 3=consolidation). The total score ranges from 0 to 36. Higher scores indicate worse lung aeration and more severe atelectasis. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Correlation Between Intraoperative Ventilation Parameters and Early Postoperative LUS Scores | From the start of anesthesia until 1 hour postoperatively. | Evaluation of the relationship between intraoperative respiratory parameters (Peak Airway Pressure \[Ppeak\], Plateau Pressure \[Pplat\], and Compliance) and early postoperative lung aeration assessed by Lung Ultrasonography (LUS) in the Post-Anesthesia Care Unit (PACU). |
| Correlation Between Intraoperative Ventilation Parameters and Postoperative Oxygenation | From the start of anesthesia until 1 hour postoperatively. | Evaluation of the relationship between intraoperative respiratory parameters (Ppeak, Pplat, and Compliance) and postoperative peripheral oxygen saturation (SpO₂) in the PACU. |
| Correlation Between Intraoperative Ventilation Parameters and Early Postoperative Pulmonary Complications | From the start of anesthesia up to 24 hours postoperatively. | Evaluation of whether intraoperative respiratory parameters (Ppeak, Pplat, and Compliance) are associated with the development of clinical pulmonary complications within the first 24 hours. |
Countries
Turkey (Türkiye)
Contacts
STUDY_DIRECTORILKAY BARAN AKKUS, MD, Associate Professor
Ankara Etlik City Hospital
Outcome results
None listed