Individual Optimal Positive End-expiratory Pressure During Robot-assisted Laparoscopic Radical Prostatectomy
- Conditions
- Pulmonary Atelectasis, Postoperative
- Interventions
- Procedure: Individualized optimal positive end-expiratory pressureProcedure: Conventional positive end-expiratory pressure
- Registration Number
- NCT04085146
- Lead Sponsor
- Seoul National University Hospital
- Brief Summary
During robot-assisted radical prostatectomy, pneumoperitoneum with Trendelenburg position is used. However, perioperative atelectasis and respiratory complications may occur with high incidence due to general anesthesia and carbon dioxide pneumoperitoneum. Intraoperative ventilatory strategy to address these issues include intraoperative recruitment maneuver and positive end-expiratory pressure (PEEP). Recently, individualized optimal PEEP with minimal driving pressure or maximal respiratory compliance was reported to reduce respiratory complications after general anesthesia. A recent version of general anesthesia ventilator provides a stepwise procedure of determining optimal PEEP by calculating respiratory compliance. We investigated whether the application of individualized optimal PEEP could reduce the incidence of atelectasis and respiratory complications after robot-assisted laparoscopic radical prostatectomy compared to uniform PEEP.
- Detailed Description
During robot-assisted radical prostatectomy, pneumoperitoneum with Trendelenburg position is used. However, perioperative atelectasis and respiratory complications may occur with high incidence due to general anesthesia and carbon dioxide pneumoperitoneum. Intraoperative ventilatory strategy to address these issues include intraoperative recruitment maneuver and positive end-expiratory pressure (PEEP). Recently, individualized optimal PEEP with minimal driving pressure or maximal respiratory compliance was reported to reduce respiratory complications after general anesthesia. A recent version of general anesthesia ventilator provides a stepwise procedure of determining optimal PEEP by calculating respiratory compliance. We investigated whether the application of individualized optimal PEEP could reduce the incidence of atelectasis and respiratory complications after robot-assisted laparoscopic radical prostatectomy compared to uniform PEEP. We plan to determine the degree of immediate postoperative atelectasis by measuring the lung ultrasound score and compare the lung ultrasound score between groups.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Male
- Target Recruitment
- 60
- Patients undergoing robot-assisted laparoscopic radical prostatectomy
- Patients receiving mechanical ventilation by Aisys Care Station anesthesia ventilator
- Patients who provided written informed consent to participate in this clinical trial
- American Society of Anesthesiologists physical status classification class 3 or more
- Moderate or more obstructive or restrictive pulmonary disease
- Preoperative adult respiratory distress syndrome or previous history of adult respiratory distress syndrome
- history of heart failure, unstable angina, increased intracranial pressure
- history of pneumothorax or presence of bullae
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Optimal PEEP Individualized optimal positive end-expiratory pressure Individualized optimal PEEP will be provided during the laparoscopic period of surgery. Optimal PEEP will be determined by the automated procedure of step-wised decrease in the amount of PEEP of the anesthesia ventilator Aisys Care Station (GE Healthcare, Madison, Wisconsin, USA). Conventional PEEP Conventional positive end-expiratory pressure A same amount of PEEP of 7 centimeter hydrogen dioxide will be provided during the laparoscopic period of surgery.
- Primary Outcome Measures
Name Time Method Difference in lung ultrasound score 10 min after surgery Difference in postoperative lung ultrasound score and baseline lung ultrasound score
- Secondary Outcome Measures
Name Time Method Composite of respiratory complication during postoperative seven days. summation of the following events: hypoxemia (pulse oximetry of 95% or less), laryngospasm, bronchospasm, pneumonia, pulmonary infiltration, aspiration pneumonia, pneumonia), pulmonary infiltration, aspiration pneumonia, development of acute respiratory distress syndrome, atelectasis, pleural effusion, pulmonary edema, pneumothorax.
Postoperative Lung ultrasound score 10 min after the end of anesthesia A scoring system with a sum of the B-line score and consolidation score by lung ultrasound examination
Length of intensive care unit stay during the postoperative one month Length of total hospital stay
Incidence of acute kidney injury during the postoperative one month Incidence of postoperative acute kidney injury
Baseline lung ultrasound score 10 min before the start of anesthesia induction A scoring system with a sum of the B-line score and consolidation score by lung ultrasound examination
Length of hospital stay during the postoperative one month Length of total hospital stay
Surgical wound infection during the postoperative one month The rate of surgical wound infection
Surgical wound dehiscence during the postoperative one month The rate of surgical wound dehiscence
Incidence of surgical re-intervention during the postoperative one month Incidence of surgical re-open
Trial Locations
- Locations (1)
Seoul National University Hospital
🇰🇷Seoul, Korea, Republic of