- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03369483
Abdominal Pressure Assessment Following Open Abdominal Surgery (AbdoPress)
Evaluation of the Abdominal Pressure Modifications in Patients Undergone to Open Abdominal Surgery and Receiving Continuous Positive Airway Pressure
During abdominal surgery, the intra abdominal pressure may increase determining lung bibasal atelectasis. The investigators hypothesized that the application of Positive End Expiratory Pressure (PEEP) promptly after extubation through Continuous Positive Airway Pressure (CPAP) would improved gas exchange, especially in those patients with abdominal pressure values close to those applied by CPAP.
The investigators have therefore designed this subset study enrolling patients randomized to receive CPAP in the "Prevention of Respiratory Insufficiency after Surgical Management (PRISM)" Trial in order to ascertain the abdominal pressure in post-surgical patients (abdominal open surgery procedures) enrolled in PRISM trial. In addition they would evaluate the effects of CPAP on abdominal pressure and consequently on arterial blood gas, and whether there is a correlation between PEEP values, abdominal pressure values and arterial blood gas.
One hundred patients included in CPAP group of the PRISM trial will be enrolled in this subset study. The investigators will perform measurements of the abdominal pressure an urinary catheter connected with an intra-abdominal pressure device (Uno-Meter ® - Uno-medical) in all patients undergoing on open-surgical procedures after mechanical ventilation withdrawal and extubation, 30 minutes and 4 hours after the application of CPAP.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Major abdominal surgery is associated with adverse changes in respiratory function.
Anaesthesia can cause reduced vital capacity, hypoxaemia and impaired central respiratory drive, while surgical manipulation can restrict ventilation, damage the respiratory muscles and cause atelectasis. These factors interact with pre-existing respiratory disease and postoperative pain to create a significant risk of pneumonia and respiratory failure, which may result in death. Evidence from one study suggests that the risk of mortality within 30 days of surgery is increased from 1% to 27% in patients with respiratory failure. Usual treatments including supplemental oxygen or respiratory physiotherapy may not always prevent deterioration in respiratory function. Subsequent respiratory failure can lead to endotracheal intubation and mechanical ventilation, which is in turn associated with a range of serious morbidities. Continuous positive airway pressure (CPAP) is a non-invasive method of supporting respiratory function. The patient breathes through a pressurized circuit against a threshold resistor that maintains a pre-set positive airway pressure during both inspiration and expiration. The findings of several trials have demonstrated the efficacy of CPAP as preventative treatment for high-risk patients following abdominal surgery by reducing the incidence postoperative pulmonary complications.
The investigators have hypothesized that the application of Positive End Expiratory Pressure (PEEP) promptly after extubation through CPAP would improved gas exchange, especially in those patients with abdominal pressure values close to those applied by CPAP.
The investigators have therefore designed this subset study enrolling patients randomized to receive CPAP in the "Prevention of Respiratory Insufficiency after Surgical Management (PRISM)" Trial in order to ascertain the abdominal pressure in post-surgical patients (abdominal open surgery procedures) enrolled in PRISM trial. In addition they would evaluate the effects of CPAP on abdominal pressure and consequently on arterial blood gas, and whether there is a correlation between PEEP values, abdominal pressure values and arterial blood gas.
One hundred patients included in CPAP group of the PRISM trial will be enrolled in this subset study. To be included in the PRISM trial, patients are required to be 50 years/old or over and to undergo major, open, intra-peritoneal surgery. Patients are excluded of meeting one or more of the following: 1) inability or refusal to provide informed consent; 2) anticipated requirement for invasive or non-invasive mechanical ventilation or at least four hours after surgery as part of routine care; 3) pregnancy or obstetric surgery; 4) previous enrolment in PRISM trial; 5) participation in a clinical trial of a treatment with a similar biological; 6) mechanism or related primary outcome measure and 7) clinician refusal.
CPAP will be provided for at least four hours, with minimal interruption, started soon after the patient has left the operating room after surgery. Administration of CPAP will only take place under the direct supervision of appropriately trained staff in an adequately equipped clinical area. The monitoring of patients receiving CPAP will be in accordance with local hospital policy or guidelines. Alterations to the administered dose will be recorded along with the reason for this change. Clinicians may only use commercially available CPAP equipment to deliver the intervention. The starting airway pressure should be 5 cmH2O and the maximal permissible airway pressure is 10 cmH2O.
The investigators will perform measurements of the abdominal pressure an urinary catheter connected with an intra-abdominal pressure device (Uno-Meter ® - Uno-medical) in all patients undergoing on open-surgical procedures after mechanical ventilation withdrawal and extubation, 30 minutes and 4 hours after the application of CPAP. Moreover, arterial blood will be sample for gas analysis at every aforementioned time-step.
Study Type
Enrollment (Anticipated)
Contacts and Locations
Study Contact
- Name: Paolo Navalesi, MD
- Phone Number: +393355321910
- Email: pnavalesi@unicz.it
Study Locations
-
-
-
Catanzaro, Italy
- Recruiting
- Magna Graecia University - University Hospital Mater Domini
-
Contact:
- Paolo Navalesi, MD
-
Ferrara, Italy
- Recruiting
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Sezione di Anestesiologia e Terapia Intensiva Universitaria, Università degli studi di Ferrara
-
Contact:
- Savino Spadaro, MD
-
Pavia, Italy
- Recruiting
- Department of Anesthesia and Intensive Care, IRCCS Policlinic San Matteo Hospital Foundation , Pavia , Italy
-
Contact:
- Silvia Poma
-
Roma, Italy
- Recruiting
- Anesthesia and Intensive Care Medicine, Sapienza University of Rome, Policlinico Umberto I Hospital
-
Contact:
- Francesco Alessandri
-
Sassari, Italy
- Recruiting
- University of Sassari
-
Contact:
- Paolo Terragni, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Patients aged 50 years or over undergoing major, open, intra-peritoneal surgery, randomized to receive Continuous Positive Airway Pressure in the "Prevention of Respiratory Insufficiency after Surgical Management (P.R.I.S.M. TRIAL)"
Exclusion Criteria:
- Inability or refusal to provide informed consent
- Anticipated requirement for invasive or non-invasive mechanical ventilation for at least four hours after surgery as part of routine care
- Pregnancy or obstetric surgery
- Previous enrollment in PRISM trial
- Participation in a clinical trial of a treatment with a similar biological mechanism or related primary outcome measure
- Clinician refusal
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
CPAP
At the end of the abdominal surgical procedure, mechanical ventilation withdrawal and extubation, patients will receive Continuous Positive Airway Pressure CPAP).
CPAP will be be delivered using any commercially available CPAP equipment.
CPAP will be started as soon as possible after the end of surgery.
The starting airway pressure (PEEP) will be 5 cmH2O.
PEEP may be changed at the discretion of the responsible physician.
The maximum permissible PEEP during the trial intervention period will be 10 cmH2O.
CPAP may be continued after the four-hour trial intervention period has finished, at the discretion of the responsible physician.
|
We will perform measurements of the abdominal pressure an urinary catheter connected with an intra-abdominal pressure device (Uno-Meter ® - Unomedical) in all patients undergoing on open-surgical procedures after mechanical ventilation withdrawal and extubation, 30 minutes and 4 hours after the application of CPAP.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Abdominal pressure in post-surgical patients (abdominal open surgery procedures)
Time Frame: Within 30 minutes by the end of surgery and mechanical ventilation withdrawn
|
Assessment of abdominal pressure through a dedicated device connected to the urinary catheter
|
Within 30 minutes by the end of surgery and mechanical ventilation withdrawn
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Abdominal pressure
Time Frame: After 30 minutes from the application of Continuous Positive Airway Pressure
|
Assessment of abdominal pressure through a dedicated device connected to the urinary catheter
|
After 30 minutes from the application of Continuous Positive Airway Pressure
|
Abdominal pressure
Time Frame: After 4 hours from the application of Continuous Positive Airway Pressure
|
Assessment of abdominal pressure through a dedicated device connected to the urinary catheter
|
After 4 hours from the application of Continuous Positive Airway Pressure
|
Arterial blood gases
Time Frame: Within 30 minutes by the end of surgery and mechanical ventilation withdrawn
|
Sample of arterial blood for gas analysis
|
Within 30 minutes by the end of surgery and mechanical ventilation withdrawn
|
Arterial blood gases
Time Frame: After 30 minutes from the application of Continuous Positive Airway Pressure
|
Sample of arterial blood for gas analysis
|
After 30 minutes from the application of Continuous Positive Airway Pressure
|
Arterial blood gases
Time Frame: After 4 hours from the application of Continuous Positive Airway Pressure
|
Sample of arterial blood for gas analysis
|
After 4 hours from the application of Continuous Positive Airway Pressure
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Paolo Navalesi, MD, Magna Graecia University, Catanzaro, Italy
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 284/2017
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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