Ventilation strategy in patients undergoing one lung ventilation
- Registration Number
- CTRI/2022/11/047212
- Lead Sponsor
- All India Institute Of Medical Sciences delhi
- Brief Summary
One lung ventilation (OLV) is used to ventilate one lung and leaving the other lung deflated and collapsed. OLV is required in thoracic surgery, cardiac surgery, and oesophagus surgery. OLV in lateral decubitus position has a significant impact on lung mechanics and oxygenation. Incidence of acute lung injury (ALI) after OLV is 2 %, with a mortality of 54% in patients who developed ALI post-OLV.1Incidence of post-operative pulmonary complications is higher with OLV as compared to other surgeries 2. Lung protective ventilation recommends using low tidal volume with higher positive end-expiratory pressure (PEEP). Very low PEEP can lead to cyclical collapse and reaeration, whereas high PEEP can lead to over distention. A single value of PEEP may not be appropriate for every patient.3 Inter-individual variability in BMI, lung characteristics, chest wall dimensions, emphasises the need to individualise PEEP for every patient.
There is no general consensus on how to set PEEP intraoperatively. Too low a PEEP can lead to atelectasis. Lung heterogeneity due to atelectasis eventually raises driving pressure (DP)4,5. Unsafe ventilatory settings is one of the most important modifiable risk factor to prevent ALI due to OLV. There are several methods to identify ideal PEEP like oxygenation, best compliance, pressure - volume (P-V) curve, stress index, lung ultrasound, etc. Several retrospective studies have suggested a close association of PEEP with lung compliance and driving pressure. DP is defined as tidal volume divided by compliance or plateau pressure minus PEEP. The concept of DP was first studied in ARDS patients and was found to be strongly associated with patient outcome. If application of PEEP leads to lung recruitment, DP will decrease and SpO2 will increase. On the other hand excess PEEP can lead to lung overdistention, fall in DP and Spo2. Thus PEEP with maximum DP can be considered ideal for the given patient. Several studies have demonstrated improved oxygenation with use of individualised PEEP. But the data was restricted till the end of the surgery only. Inadequate lung recruitment while shifting the patient from OLV to TLV and loss of PEEP during the weaning phase at the end of the surgery can have a negative impact on the outcome as well.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Completed
- Sex
- All
- Target Recruitment
- 40
Patients undergoing elective thoracotomy surgery with OLV lobectomy metastatectomy esophagectomy chest wall resection surgery ASA Physical Status I, II and III.
Patients who do not give consent for the study Patients with Body Mass Index (BMI) < 18.5 kg/m2 and > 35 kg/m2 Patients with moderate to severe derangements in Pulmonary Function Tests Moderate to severe ARDS Presence of bullae, pneumothorax in Chest Xray or CT scan Severe COPD patients COPD patients requiring oxygen therapy or CPAP Previous lung resection surgery.
Study & Design
- Study Type
- Interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method To study the impact of alveolar recruitment followed by individualised PEEP on the oxygenation during and after OLV 24 hours from surgery
- Secondary Outcome Measures
Name Time Method Change in driving pressure, plateau pressure, peak pressure at selected time points 24 hours from surgery Change in pH, PaO2, PCO2, lactate at selected time points T1 5 minutes after induction, supine, TLV Change in haemodynamic parameters PPV MAP HR SpO2 T1 5 minutes after induction supine TLV Post-operative pulmonary complications 30 days from surgery
Trial Locations
- Locations (1)
All India Institute Of Medical Sciences
🇮🇳East, DELHI, India
All India Institute Of Medical Sciences🇮🇳East, DELHI, IndiaPratishtha YadavPrincipal investigator7011553571pratishthayadav88@gmail.com