The Effect of Different I:E Ratio on Gas Exchange of Patients Undergoing Gynecologic Laparoscopic Surgery With Trendelenburg Position
- Conditions
- Uterine MyomaOvarian CystLaparoscopic Gynecologic Surgery
- Interventions
- Procedure: external PEEP
- Registration Number
- NCT01379313
- Lead Sponsor
- Samsung Medical Center
- Brief Summary
In patients undergoing gynecologic laparoscopic surgery with trendelenburg position, the disturbance of pulmonary gas exchange frequently occurs due to high intra-abdominal pressure. The investigators tried to evaluate the effect of various inspiratory to expiratory ratio on pulmonary gas exchange by randomized controlled trial.
- Detailed Description
In patients undergoing gynecologic laparoscopic surgery with trendelenburg position, the disturbance of pulmonary gas exchange frequently occurs due to high intra-abdominal pressure. During the laparoscopic surgery with abdominal gas insufflation, gas exchange disturbance such as CO2 retention, hypoxemia occurs in addition to high plateau airway pressure. The usual strategy against these kinds of problem is pressure-controlled ventilation. However, the gas exchange problem especially CO2 retention can not be solved in some cases. The inverse-ratio ventilation (IRV), which prolongs the inspiratory time greater than expiratory time, can be applied for adult respiratory distress syndrome. The efficacy of IRV is to improve gas-exchange status by increasing mean airway pressure and alveolar recruitment. There have been several clinical investigations which applied IRV during general anesthesia. However, there have been debates about the effect of IRV during general anesthesia. Therefore, we tried to apply the IRV for subjects undergoing laparoscopic surgery, and evaluate the effect of different I:E ratio on the pulmonary gas exchange and respiratory mechanics.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 100
- patients undergoing elective gynecologic laparoscopic surgery
- the duration of pneumoperitoneum during laparoscopic surgery is more than 40 minutes
- ASA (American society of anesthesiologists) classification of the subjects more than III.
- Age under 20, or more than 65 years.
- Past history of pneumothorax, COPD, asthma.
- Patients with ischemic heart disease, valvular heart disease.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description 1:2 PEEP group external PEEP I:E ratio of 1:2 with external PEEP of 5 cm H2O
- Primary Outcome Measures
Name Time Method arterial CO2 partial pressure 60 minutes after start of pneumoperitoneum arteial CO2 partial pressure
- Secondary Outcome Measures
Name Time Method Mean airway pressure 10 min after induction, 30 and 60 min after start of pneumoperitoneum Mean airway pressure
arterial O2 partial pressure 10 min after induction, 30 and 60 min after start of pneumoperitoneum arterial O2 partial pressure
tidal volume (setting) 10 min after induction, 30 and 60 min after start of pneumoperitoneum tidal volume (setting)
hemodynamic parameters 10 min after induction, 30 and 60 min after start of pneumoperitoneum systolic/ diastolic blood pressure, heart rate, mean blood pressure
end-tidal CO2 partial pressure 10 min after induction, 30 and 60 min after start of pneumoperitoneum end-tidal CO2 partial pressure
respiratory compliance 10 min after induction, 30 and 60 min after start of pneumoperitoneum Dynamic compliance, Static compliance
Dead space 10 min after induction, 30 and 60 min after start of pneumoperitoneum physiologic dead space / tidal volume (VD/VT)
work of breathing 10 min after induction, 30 and 60 min after start of pneumoperitoneum work of breathing
peak inspiratory pressure 10 min after induction, 30 and 60 min after start of pneumoperitoneum peak inspiratory pressure
plateau pressure 10 min after induction, 30 and 60 min after start of pneumoperitoneum plateau pressure
positive end-expiratory pressure 10 min after induction, 30 and 60 min after start of pneumoperitoneum positive end-expiratory pressure
tidal volume (exhaled) 10 min after induction, 30 and 60 min after start of pneumoperitoneum tidal volume (exhaled)
minute ventilation 10 min after induction, 30 and 60 min after start of pneumoperitoneum minute ventilation
Trial Locations
- Locations (1)
Samsung Seoul Hospital, Samsung Medical Center
🇰🇷Seoul, Korea, Republic of