Study to Determine if Using Ventilation During Open Heart Surgery Improves Lung Outcomes (PEEP)
Effect of Continuous Mechanical Ventilation During Cardiopulmonary Bypass on The Lung Mechanics: A Prospective Evaluation
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This is a prospective, randomized, blinded study with a control group. The study group will receive mechanical ventilatory support during CBB, which consists of a preset/predetermined tidal volume, respiratory rate, positive pressure at the end of expiration and FIO2. The control group will receive CPB without additional mechanical ventilatory support during surgery, which at present is the standard of care.
The difference between the study and the control group will occur during the time the heart is arrested and the lungs, under present standard of care, are no longer ventilated. It is at this point in time that those in the study group will continue to receive ventilation, intermittent positive pressure ventilation, while their heart is arrested. The subjects will have their lungs ventilated six times per minute with a tidal volume equal to 7-10 milliliters per kilogram. This range, when combined with a consistent PEEP of 5cm of water pressure, will allow for the peak inspiratory pressure to be maintained at or below 40cm of water pressure. In addition, the FIO2 will remain consistent at the same level that was needed to maintain the pulse oximetry at 94% as well as the end-tidal CO2 at 35mmHg. The values mentioned for this study have been chosen based on not only investigator preference, but also on what is considered "minimally necessary" to prevent atelectasis. Multiple studies have been done utilizing PEEP at 5 and 10 cm of water pressure. With the exception of the potential for mechanical ventilation during the CBP, the care of the subject, regardless of the group randomized into, will be the same. We will in all other aspects continue to utilize the current standard of care.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Wisconsin
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Green Bay, Wisconsin, United States, 54311
- Aurora BayCare Medical Center
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- any patient of any gender, any age with known coronary artery disease that will undergo elective Coronary Artery Bypass Grafting (CABG) and will require CPB as part of his/her operative technique.
Exclusion Criteria:
- documented ejection fraction (either by echocardiogram or by cardiac catheterization) equal to or below 20%
- patients with cardiac valvular disease
- patients with a spirometry measurement that demonstrates an FEV1/FVC ratio below 60%
- patients with chronic renal failure who require dialysis or
- those who have experienced an allergic reaction to anesthesia in the past
- patients with a history of lung infiltrate on chest X-ray prior to surgery or a history of asthma
- Women who are pregnant are excluded
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
No Intervention: Control
half of the study subjects will receive standard of care during their open heart surgery.
|
|
|
Experimental: Treatment
half of the study subjects will receive the prescribed ventilatory support during open heart surgery.
|
Those in the treatment group will receive ventilation, intermittent positive pressure ventilation, while their heart is arrested.
The subjects will have their lungs ventilated six times per minute with a tidal volume equal to 7-10 milliliters per kilogram.
This range, when combined with a consistent PEEP of 5cm of water pressure, will allow for the peak inspiratory pressure to be maintained at or below 40cm of water pressure.
In addition, the FIO2 will remain consistent at the same level that was needed to maintain the pulse oximetry at 94% as well as the end-tidal CO2 at 35mmHg.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Post-surgical lung function, compliance, tissue oxygenation, and radiographic changes indicative of atelectasis.
Time Frame: During in-patient stay
|
Determination if ventilation during surgery improves post-surgical lung function, compliance, tissue oxygenation, and radiographic changes indicative of atelectasis.
|
During in-patient stay
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Raul Mendoza-Ayala, MD, Aurora Health Care
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- PEEP
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