Feasibility of ETCO₂ Changes During Passive Leg Raise for Fluid Management in Lung Surgery

Not Applicable

Completed

• Conditions: Lung Cancer

• Registration Number: NCT06855966
• Lead Sponsor: Istanbul University - Cerrahpasa

Brief Summary

Aim: End tidal carbondioxide pressure (EtCO2) is an indirect indicator of cardiac output (CO) which is monitored in every patient at perioperative setting. The investigators aimed to use increase of EtCO2 as a response to passive leg raising maneuver (PLR) to indicate fluid responsiveness in patients who underwent lung resection with video-assisted thoracoscopic surgery (VATS).

Detailed Description

Materials and Methods: 50 patients included who are eligible according to inclusion criteria of the study who underwent lung resection operation via VATS between Agust 2020-March 2021. After a standardized anesthesia induction protocol and intubation, PLR is applied to all patients as soon as anesthesia depth and ventilation stabilized. An increase of 2 mmHg at EtCO2 at first minute of PLR evaluated as "fluid responsive" due to an increase of venous return. Responsive patients divided into two groups as "study" and "control" when unresponsive patiens inclueded into "unresponsive" group. Patients at study group received a fluid bolus (250 ml (and an additional 250 ml if mean arterial pressure remained below 65 mmHg )) in addition to maintainence fluid as control group and unresponsive group received only maintainence fluid. Hemodynamic data, surgery duration, total iv fluid administration, use of blood products, bleeding and urine output during surgery of all patients recorded. Preopretive and postoperative urea, creatinine and lactate levels of all patiens compared. Total iv fluid administration and urine output recorded during postoperative 24 hours.

Study Timeline

• Study Start: 2020-08-04
• Primary Completion: 2021-03-14
• Study Completion: 2021-03-15
• Study First Submitted: 2025-02-05
• Status Verified: 2025-03
• Study First Submitted QC: 2025-03-01
• Last Update Submitted: 2025-03-01
• Study First Posted: 2025-03-25
• Last Update Posted: 2025-03-25

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 53

Inclusion Criteria

• Patients undergoing lung resection surgery via VATS
• ASA I-II-III
• Patients older than 18 years

Exclusion Criteria

• ASA IV or more
• Post operative ICU stay
• Resections greater than lobectomy
• History of renal and heart failure
• Patients younger than 18 years.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Change in End-Tidal Carbon Dioxide (EtCO₂) in Response to Passive Leg Raise (PLR)	Time Frame: Intraoperative (Baseline and 1 Minute After PLR)	Measurement Method: EtCO₂ (mmHg) will be recorded using a side-stream capnograph integrated into the anesthesia workstation. Baseline EtCO₂ will be measured in the supine position before the PLR maneuver. The PLR maneuver will then be performed by elevating the lower extremities to a 45-degree angle while maintaining a supine upper body position. The position remained for 1 minute and the maximum level of EtCO₂recorded.; Outcome Definition: A ≥2 mmHg increase in EtCO₂ from baseline within 1 minute of PLR will be classified as a positive response, indicating fluid responsiveness. Patients with an EtCO₂ increase of \<2 mmHg will be classified as non-responders.

Secondary Outcome Measures

Name	Time	Method
Change in Serum Urea Levels	Preoperative, 24 hours, and 48 hours postoperatively (if patient remains hospitalized)	Blood samples will be collected at baseline (preoperative), and at 24 hours postoperatively for all participants. If the patient remains hospitalized at 48 hours, an additional blood sample for urea will be collected. Serum urea (mg/dL) levels will be analyzed using standard laboratory biochemical methods.
Change in Serum Creatinine Levels	Preoperative, 24 hours, and 48 hours postoperatively (if patient remains hospitalized)	Blood samples will be collected at baseline (preoperative), and at 24 hours postoperatively for all participants. If the patient remains hospitalized at 48 hours, an additional blood sample for creatinine will be collected. Serum creatinine (mg/dL) levels will be analyzed using standard laboratory biochemical methods.
Change in Serum Lactate Levels	Preoperative, 24 hours	Blood samples will be collected at baseline (preoperative), and at 24 hours postoperatively for all participants. Serum lactate (mmol/L) levels will be analyzed using standard laboratory biochemical methods.

Trial Locations

Locations (1)

Istanbul University-Cerrahpasa Medical School Hospital; 🇹🇷 Istanbul, Turkey