- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01911923
Ventilation Strategy Reduces Postoperative Atelectasis
Reduction in Postoperative Atelectasis by Continuous Positive Airway Pressure and Low Oxygen Concentration After Endotracheal Extubation.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
During general anesthesia, the combination of reduced functional residual capacity (FRC), high inspiratory oxygen fraction (FIO2), and airway closure are the main factors implicated in the atelectasis, shunt and shunt-like effects that account for the majority of the impaired oxygenation seen during general anesthesia.
Previous studies have shown that formation of atelectasis during preoxygenation and induction of anesthesia can be avoided by adding a continuous positive airway pressure (CPAP) followed by a positive end-expiratory pressure (PEEP).During emergence from anesthesia, high concentrations of oxygen predispose to atelectasis formation. Even a recruitment maneuver, followed by ventilation with 100% oxygen with a PEEP/CPAP of 10 cm H2O until extubation, failed to improve postoperative oxygenation compared with that achieved with zero end-expiratory pressure (ZEEP).This failure may have been caused by the presence of lung regions with high oxygen concentrations.
The investigators hypothesized that by inducing and discontinuing anesthesia during CPAP/PEEP and deliberately reducing FIO2 after extubation, postoperative atelectasis would be reduced compared with standard protocols. To test our hypothesis, the investigators studied 1) a control group with no CPAP/PEEP and a FIO2 of 1.0 while breathing spontaneously after extubation, and 2) an intervention group that was on CPAP/PEEP of 6 cmH2O from induction to extubation and that received an FIO2 of 1.0 until extubation and then an FIO2 of 0.3 via a facemask while on CPAP after extubation.
Study Type
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Västmanland
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Köping, Västmanland, Sweden, 721 89
- Västmanlands sjukhus Köping
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Adult patients up to 75 years of age.
- American Society of Anesthesiologists (ASA) physical status class I-III.
- Be able to climb two flight of stairs without stopping.
- SpO2 of ≥ 94% when breathing air in the supine position.
- A body mass index (BMI, weight in kilograms divided by the square of the height in meters) of < 31.
Exclusion Criteria:
- Patients with chronic obstructive pulmonary disease.
- Smokers.
- Ex smokers if smoked more than 5 pack years.
- Overt heart failure
- Known or predicted difficult intubation.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: No CPAP/PEEP and 100 % oxygen
This is the control group
|
This is the control group and 100 % oxygen will be used during induction of and emergence from anesthesia, no enhanced level of CPAP/PEEP is implemented.
During controlled ventilation ventilation mode is volume controlled.
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Experimental: CPAP/PEEP and 30 % oxygen
This is the intervention group
|
During all phases of anesthesia CPAP/PEEP will be used together with 100 % oxygen during induction of as well during emergence from anesthesia until after extubation when 30 % oxygen will be used.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Area of atelectasis
Time Frame: 30 minutes
|
The area of atelectasis is investigated by computed tomography of the lungs postoperatively
|
30 minutes
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Peripheral oxygen saturation (SpO2)
Time Frame: 2 hours
|
SpO2 is assessed immediately after extubation and then continuously postoperatively
|
2 hours
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Lennart Edmark, Md, Landstinget Vastmaland
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- Dnr 2008 / 251
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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