Post-operative respiratory failure
Conditions
Interventions
1. The conventional group will be ventilated with low PEEP (max 2cm H2O), without recruitment
2. The interventional groep will be ventilated with higher PEEP (12cm H2O), with intra-operative recruitment maneuvres.
Sponsors
None listed
Eligibility
Inclusion criteria
Inclusion criteria: 1. Planned elective abdominal surgery; 2. General anesthesia with intravenous medication; 3. High or intermediate risk for postoperative pulmonary complications.
Exclusion criteria
Exclusion criteria: 1. Age 40 kg/m2; 3. Laparoscopic surgery; 4. Previous lung surgery (any); 5. Persistent hemodynamic instability, intractable shock (considered hemodynamic unsuitable for the study by the patient’s managing physician); 6. History of previous severe chronic obstructive pulmonary disease (COPD) (non–invasive ventilation and/or oxygen therapy at home, repeated systemic corticosteroid therapy for acute exacerbations of COPD); 7. Recent immunosuppressive medication (patients receiving chemotherapy or radiation therapy, less than 2 months after chemotherapy or radiation therapy); 8. Severe cardiac disease (New York Heart Association class III or IV, or acute coronary syndrome, or persistent ventricular tachyarrhythmia’s); 9. Mechanical ventilation > than 30 minutes (e.g., in cases of general anesthesia because of surgery) within last 30 days; 10. Pregnancy (excluded by laboratory analysis); 11. Acute lung injury or acute respiratory distress syndrome expected to require prolonged postoperative mechanical ventilation; 12. Neuromuscular disease (any); 13. Consented for another interventional study or refusal to participate in the study.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Postoperative pulmonary complications: 1. Mild or severe respiratory failure; 2. ALI/ARDS; 3. Suspected pulmonary infection; 4. Pulmonary infiltrate on chest X-ray; 5. Atelectasis; 6. Pneumothorax; 7. Bronchospasm; 8. Aspiration pneumonitis; 9. Cardiopulmonary edema. | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Intra–operative complications (desaturation, barotrauma, hypotension during recruitment, need for vasopressors); 2. Need for ICU admission (if not as part of routine) or ICU readmission; 3. Hospital–free days at day 90; 4. Post–operative non–pulmonary organ function; 5. Post–operative wound healing; 6. Systemic levels of markers of pulmonary inflammation, acute lung injury and markers of distal organ injury. | — |
Contacts
Public ContactMarcus J. Schultz
Meibergdreef 9, C3-415
Outcome results
None listed