The Open Lung Approach During One Lung Ventilation in Thoracic Surgery

Not Applicable

Completed

• Conditions: Hypoxemia
• Interventions: Procedure: Recruitment maneuver

• Registration Number: NCT03435523
• Lead Sponsor: University of Foggia

Brief Summary

* Question: Ventilatory strategy to counterbalance the effect of one lung ventilation during thoracic surgery.

* Findings: the open lung approach improved oxygenation and lung compliance, reducing respiratory system driving pressure and transpulmonary driving pressure.

* Meaning: patients undergoing thoracic surgery during one lung ventilation may benefit of an open lung approach strategy to avoid ventilator lung injury.

Detailed Description

Background: During thoracic surgery in lateral decubitus, one lung ventilation (OLV) may impair respiratory mechanics and gas exchange. The investigators tested a strategy based on an open lung approach (OLA) consisting in lung recruitment immediately followed by a decremental positive-end expiratory pressure (PEEP) titration to the best respiratory system compliance (CRS) and separately quantified the elastic properties of the lung and the chest wall. The investigators hypothesis was that this approach would improve gas exchange and increase lung compliance (CL).

Methods: In thirteen patients undergoing upper left lobectomy the investigators studied lung and chest wall mechanics, transpulmonary pressure (PL), respiratory system and transpulmonary driving pressure (ΔPRS and ΔPL), gas exchange and hemodynamics at two time-points (a) during OLV at zero end-expiratory pressure (OLVpre-OLA) and (b) after the application of the open-lung strategy (OLVpost-OLA).

Study Timeline

• Study Start: 2012-02-01
• Primary Completion: 2012-11-30
• Study Completion: 2012-11-30
• Status Verified: 2018-02
• Study First Submitted: 2018-02-08
• Study First Submitted QC: 2018-02-14
• Last Update Submitted: 2018-02-14
• Study First Posted: 2018-02-19
• Last Update Posted: 2018-02-19

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 24

Inclusion Criteria

• age > 18 years,
• surgery and OLV lasting ≥ 60 min

Exclusion Criteria

• lung reduction surgery, pneumonectomy, patients with severe COPD with preoperative forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio, expressed as a percentage (FEV1/FVC%) <60%, presence of large bullae, pleural diseases and/or acute or chronic uncompensated cardiac disease

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Open lung approach	Recruitment maneuver	Recruitment maneuver during OLV in thoracic surgery

Primary Outcome Measures

Name	Time	Method
Change in respiratory mechanics before and after the open lung approach	During surgery	Respiratory mechanics parameters were recorded, digitized and collected on a personal computer through a 12-bit analog-to digital converter board (DAQCard 700; National Instrument, Austin, TX) at a sample rate of 200 Hz (ICU Lab, KleisTEK Engineering, Bari, Italy).