Respiratory Anaesthesia
Conditions
Sponsors
Ain Shams university hospitals
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: -Age: From 18 years till 55 years. -Sex: Male or Female. -Expected duration of surgery (from incision to closure) exceeds 2 h. -To identify the risk for PPCs, the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score is used (Canet el al., 2010). This score predicts individual preoperative risk for PPCs using seven independent predictors, four of which are patient-related and three of which are surgery-related. An ARISCAT risk score =26 is associated with an intermediate to high risk for PPCs.
Exclusion criteria
Exclusion criteria: -Age: below 18 years or above 55 years. -Patient refusal to give written informed consent. -Pregnant patients. -Patients with persistent hemodynamic instability or intractable shock. -Patients with a history of severe chronic obstructive pulmonary disease (COPD); defined as non-invasive ventilation and/or oxygen therapy at home or repeated systemic corticosteroid therapy for acute exacerbations of COPD), severe cardiac disease (defined as New York Heart Association class III or IV, acute coronary syndrome, or persistent ventricular tachyarrhythmia), concurrent acute respiratory distress syndrome (ARDS) expected to require prolonged post-operative mechanical ventilation, severe pulmonary arterial hypertension (defined as systolic pulmonary arterial pressure >40 mmHg). -Patients with intracranial injury, or tumour or neuromuscular disease. -Morbid obesity: obese patients with BMI =35 kg/m2. -Patients who have undergone any kind of previous lung surgery, have been invasively mechanically ventilated for longer than 30 minutes within the last 30 days before surgery, or have received recent immunosuppressive medication (chemotherapy or radiation therapy up to 2 months prior to surgery). -Need for one-lung ventilation or planned re-intubation following surgery, or need for intra-operative prone or lateral decubitus position.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The primary endpoint of this trial is the development of PPCs within the first 5 post-operative days. Patients who develop a least one complication are considered as meeting the primary endpoint. PPCs are defined as follows: respiratory failure, ARDS, Bronchospasm, Pulmonary infection, Aspiration pneumonitis, Pleural effusion, Atelectasis, Cardiopulmonary edema, Pneumothorax. | — |
Secondary
| Measure | Time frame |
|---|---|
| Alveolar PO2 will be calculated from the alveolar gas equation: PAO2 = FiO2 (PB - PH2O) where PAO2 is partial pressure of alveolar O2, PiO2 is partial pressure of inspired O2, PB is barometric atmospheric pressure (760 mm Hg), and PH2O is partial pressure of water vapor (47 mm Hg at normal body temperature).which will need arterial blood gas samples to be taken pre-operatively, intra-operatively and post-operatively to measure partial pressure of oxygen (PaO2) and to calculate alveolo-arterial PaO2 gradient (A-a PaO2). ; Both surgery- and anaesthesia-related data are recorded, including duration of surgery (from incision to closure), patient positioning during operation, duration of anaesthesia (from intubation to extubation), anaesthetic procedure details, drugs and fluids administered during anaesthesia (e.g., anaesthetics, vasoactive drugs, transfusion). Ventilator settings, haemodynamics, need for rescue strategy and deviation from the ventilation protocol. ;length of stay in the PACU, Visual Analogue Score, post-operative analgesic requirements and the use of a non-rebreathing O2 mask (100% FiO2) or reintubation are also recorded. | — |
Countries
Egypt
Contacts
Public ContactMohamed Alaaeldin Mohamed Elsayed Radwan
Assistant lecturer
Outcome results
None listed