Optimal Level of Positive End-expiratory Pressure to Reduce Postoperative Atelectasis After Lung Resection With Protective One-lung Ventilation
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 142
- Locations
- 1
- Primary Endpoint
- Modified lung ultrasound score
Study Overview
Brief Summary
Protective ventilation strategy has been widely applied in the field of thoracic surgery requiring one-lung ventilation to reduce postoperative pulmonary complications. Low tidal volume, positive end-expiratory pressure (PEEP), and intermittent recruitment maneuver are key components of protective ventilation strategy. Recent evidence suggests that a tidal volume of 4-5 ml/kg should be applied during protective one-lung ventilation. However, optimal level of PEEP is still unclear. This study aims to investigate optimal level of PEEP to minimize postoperative atelectasis by comparing modified lung ultrasound score in patients applied protective one-lung ventilation using PEEP of 3, 6, or 9 cm of water during thoracic surgery.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Triple (Participant, Care Provider, Outcomes Assessor)
Eligibility Criteria
- Ages
- 19 Years to 80 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Patients undergoing Video-assisted Thoracic Surgery under one-lung ventilation
Exclusion Criteria
- •Moderate to severe obstructive/restrictive pattern in preoperative pulmonary function test
- •Chronic kidney disease
- •Coronary artery disease
- •Pulmonary hypertension
- •Bilateral lung surgery
- •Conversion to thoracotomy
- •American Society of Anesthesiologists physical status IV or more
- •Refusal to participate
Arms & Interventions
PEEP 3 cm of water
Patients allocated in this group will be applied protective one-lung ventilation using tidal volume of 5 ml/kg predicted body weight with PEEP of 3 cm of water during thoracic surgery.
Intervention: PEEP 3 cm of water (Procedure)
PEEP 6 cm of water
Patients allocated in this group will be applied protective one-lung ventilation using tidal volume of 5 ml/kg predicted body weight with PEEP of 6 cm of water during thoracic surgery.
Intervention: PEEP 6 cm of water (Procedure)
PEEP 9 cm of water
Patients allocated in this group will be applied protective one-lung ventilation using tidal volume of 5 ml/kg predicted body weight with PEEP of 9 cm of water during thoracic surgery.
Intervention: PEEP 9 cm of water (Procedure)
Outcomes
Primary Outcomes
Modified lung ultrasound score
Time Frame: Postoperative 1 hour
The score is calculated by adding up the 12 individual quadrant scores assessed using lung ultrasound.
Secondary Outcomes
- plasma Tumor Necrosis Factor-α(10 minutes after initiation of one-lung ventilation)
- Intraoperative desaturation(Average time of 60-90 minutes)
- Intraoperative partial pressure of arterial oxygen/fraction of inspired oxygen ratio(Average time of 60-90 minutes)
- Postoperative desaturation(Postoperative 24 hours)
- plasma Interleukin-6(10 minutes after initiation of one-lung ventilation)
- plasma Interleukin-10(10 minutes after initiation of one-lung ventilation)
- Postoperative pulmonary complication(Postoperative 7 days)
Investigators
Jae-Hyon Bahk, MD, PhD
Professor
Seoul National University Hospital