Driving pressure guided positive end expiratory pressure (PEEP) vs fixed PEEP in preventing lung collapse

Completed

Conditions: Medical and Surgical, (2) ICD-10 Condition: N998||Other intraoperative and postprocedural complications and disorders of genitourinary system,

Brief Summary: - The study will be done on patients undergoing laparoscopic urological or gynecological surgeries in trendelenberg position.

- 82 randomized patients will be recruited of which 41 patients will be assigned to study group and 41 patients will be assigned to control group.

- The participants in the test group shall receive driving pressure guided individualized PEEP and the control group participants shall receive fixed PEEP throughout the surgery.

- Driving pressures would be calculated by using the formula (Pplat - PEEP) and the PEEP at which lowest possible driving pressures are observed is fixed throughout the surgery.

- Lung recruitment will be done in both the study groups. Incremental PEEP protocol shall be used in test group.

- The principal investigator is blinded to the study groups and the intervention will be done by an experienced anesthesiologist in the operation theater.

- After the patient is shifted to the post anesthetic care unit lung ultrasound will be done by the principal investigator to look for any B lines and lung consolidation and Lung Ultrasound Sore (LUS) will be determined based on USG findings.

- Other parameters like intra operative arterial blood gas analysis, ventilatory parameters, vitals, details of the surgery will be recorded in the case record form.

- On completion both the groups will be studied and analyzed independently and various parameters mentioned above will be compared.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

1. Patients refusal to participate in the study 2) Previous thoracic surgeries or massive blood loss >40ml/Kg 3) Patients with ARDS / lung injury / COPD / chronic lung disease.
1. Recent history of upper respiratory tract infection/ history of bronchial asthma 5) Significant cardiac, renal or hepatic disease.
BMI <18 or >30 Kg/m2.

Primary Outcome Measures

Name	Time	Method
To identify whether an individualized PEEP guided by driving pressures can reduce the magnitude of postoperative ( 30 minutes after extubation) lung atelectasis as compared to a fixed PEEP assessed by change in modified lung ultrasound score	24 hours after extubation of the patient

Secondary Outcome Measures

Name	Time	Method
Post operative oxygen requirement	Post operative period

Locations (1): All India Institute of Medical Sceinces, Raipur
🇮🇳
Raipur, CHHATTISGARH, India
All India Institute of Medical Sceinces, Raipur
🇮🇳Raipur, CHHATTISGARH, India
Dr Sudeep Takoor
Principal investigator
9538104933
sudeeptakoor1@gmail.com