A Randomized comparative study to compare the effect of normocarbia vs permissive hypercarbia on arterial oxygenation during one lung ventilation in lung surgeries at SMS medical college , jaipur
试验速览
- 阶段
- 4 期
- 状态
- 尚未招募
- 入组人数
- 74
- 试验地点
- 1
- 主要终点
- Mean PaO2 in both study group.
研究概览
简要总结
One lung ventilation has become accepted procedure where lung isolation and sepration is required in thoracic surgeries . During one lung ventilation (OLV) diseased lung is collapsed which is being operated while ventilation of the other lung is required to facilitate better surgical access and visibility in lung surgeries. We use double-lumen endotracheal tubes (DLT) or bronchial blocker for OLV. This technique helps to prevent contamination of normal lung and improve surgical ability.
During one-lung ventilation (OLV) the nonventilated lung remains perfused but not ventilated, leading to an increase in shunt fraction and a decrease in oxygenation. This obligatory intrapulmonary shunt may produce hypoxemia because of collapse of the nondependent lung and increased atelectatic areas in the dependent lung. It leads to ventilation -perfusion mismatch.
Hypoxic Pulmonary Vasoconstriction shunts divert blood away from poorly oxygenated areas to better ventilated lung segments, thereby optimizing ventilation-perfusion matching, reducing shunt fraction and optimizing systemic O2 delivery.
Oxygenation during OLV can be improved by increasing blood flow to the ventilated lung or decreasing blood flow to the nonventilated lung.
Carbon dioxide is a potent vasodilator in cerebral and systemic circulation. However the effect of CO2 on pulmonary circulation is unclear.
Permissive hypercapnia refers to the ventilator strategy that allows the Pco2 to rise in a controlled fashion in an effort to reduce lung injury and the burden of gas exchange. Although a Pco2 value of 40 mm Hg is considered normal in healthy humans, higher values may be adaptive in disease. Permissive hypercapnia can be achieved by reductions in respiratory rate or tidal volume, or both.
In this study, we tested the hypothesis that hypercarbia within permissible limits may have effect in improving arterial oxygenation compared to normocarbia during OLV in patients undergoing lung surgeries.
研究设计
- 研究类型
- Observational
入排标准
- 年龄范围
- 18.00 Year(s) 至 80.00 Year(s)（—）
- 性别
- All
入选标准
- •Age above 18 years ASA grade 1 to 3 Patients undergoing elective lung surgeries (thoracotomy, pneumonectomy, lobectomy, bilobectomy, segmentectomy etc.) Patients who will give informed written consent.
排除标准
- •1.Patient should not be a part of other study.
- •2.Non co-operative patient.
- •3 .Patient who presented with cardiac arrhythmias
- •History of heart failure, vascular disease, chronic obstructive pulmonary disease, restrictive pulmonary disease or increased increased intracerebral pressure
- •Evidence of any liver or kidney disease
- •Patients with haemostatic disorders
- •Previously existing chronic respiratory disease of non-operated lung.
结局指标
主要结局
Mean PaO2 in both study group.
时间窗: Baseline , after 30 minutes
Mean change in haemodynamic variables- HR,SBP,DBP,MAP
时间窗: Baseline , after 30 minutes
Mean change in respiratory variables - Pmean, Pplateau, dynamic compliance etc
时间窗: Baseline , after 30 minutes
次要结局
- Mean change in heamodynamic variables and respiratory variables(30 minutes)
研究者
Dr Indu verma
Sms medical college , jIpur