Effect of Intraoperative PEEP Individualization According to Driving Pressure in Major Abdominal Surgery
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Mechanical Ventilation Complication
- Sponsor
- Mongi Slim Hospital
- Enrollment
- 100
- Primary Endpoint
- incidence of pulmonary post operative complications
- Status
- Not yet recruiting
- Last Updated
- 3 years ago
Overview
Brief Summary
In this prospective, randomized trial, including patients scheduled for a major open or laparoscopic abdominal surgery (duration >2 hours) under general anesthesia , the investigators will compare 2 strategies of protective mechanical ventilation: a fixed intraoperative PEEP of 6 cmH2O and an individualized intraoperative PEEP according to the driving pressure.
Detailed Description
Patients will be randomized into 2 groups: * Fixed PEEP group: will receive protective intraoperative mechanical ventilation: tidal volume: 6 ml/kg of PBW, recruitment maneuvers every immediately after tracheal intubation and every 2 hours and a fixed PEEP of 6 cmH2O * Individualized PEEP: protective mechanical ventilation with the same modality with an individualization of PEEP levels hourly in order to achieve the lowest driving pressure. PEEP levels will be adjusted after intubation and hourly by increasing or decreasing PEEP levels every 10 respiratory cycles. The primary outcome: incidence of post operative pulmonary complications during the first post operative days.
Investigators
Mhamed Sami Mebazaa
Professor head of anesthesia and intensive care department
Mongi Slim Hospital
Eligibility Criteria
Inclusion Criteria
- •BMI\<35, ARISCAT score \> 26, patients scheduled for major abdominal surgery
Exclusion Criteria
- •unplanned post operative ICU stay and mechanical ventilation
Outcomes
Primary Outcomes
incidence of pulmonary post operative complications
Time Frame: first 7 post operative days
SpO2\< 92%, new chest Xray infiltrates, acute respiratory failure requiring intervention
Secondary Outcomes
- lung aeration score (LAS)(day 1, day 3 and day 7 after surgery)