Differential Lung Ventilation vs. CPAP

Differential Lung Ventilation vs. CPAP During One Lung Ventilation for Video Assisted Lung Surgery

In this study we compared the efficacy of continuous positive airway pressure (CPAP) to differential lung ventilation, in terms of patient's oxygenation, during video assisted thoracoscopic lung resection.

Study Overview

• Status: Completed
• Conditions: One Lung Ventilation; Continuous Positive Airway Pressure; Differential Lung Ventilation
• Intervention / Treatment: Device: cpap

Detailed Description

Background: One Lung Ventilation (OLV) is the technique used during lung resection surgery in order to facilitate optimal surgical conditions. OLV may result in hypoxemia due to the shunt created. Several techniques are used to overcome the hypoxemia, one of which is continuous positive airway pressure (CPAP) to the non-dependent lung. Another technique is ventilating the non-dependent lung with a minimal volume, thus creating differential lung ventilation (DLV). In this study we compared the efficacy of CPAP to DLV during video assisted thoracoscopic lung resection.

Patients and Method: This is a prospective study of 30 adult patients undergoing elective video assisted thoracoscopic lung lobectomy. Each patient was ventilated in four modes: two lung ventilation, OLV, OLV+CPAP and OLV+DLV. Fifteen patients were ventilated with CPAP first and DLV next, and the other 15 were ventilated with DLV first and then CPAP. Five minutes separated each mode, during which the non-dependent lung was open to room air. We measured the patient's arterial blood gas during each mode of ventilation. The surgeons, who were blinded to the ventilation technique, were asked to assess the surgical conditions at each stage.

• Study Type: Interventional
• Enrollment (Actual): 29
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Israel
  • Haifa, Israel
    • Rambam Health Care Campus

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 78 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Adult patients diagnised with lung cancer
2. Scheduled to have thoracoscopic lung lobectomy -

Exclusion Criteria:

1. Pregnancy
2. ASA>=4
3. Difficult intubation -

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: cpap first, differential ventilation later	Device: cpap; application of cpap to the non-dependent lung, during one lung ventilation
Active Comparator: differential ventilation first, cpap late	Device: cpap; application of cpap to the non-dependent lung, during one lung ventilation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
arterial blood oxygenation	PaO2	intraoperative

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
interference with surgical field exposure	interference	intraoperative
airway pressure in the dependent lung during one lung ventilation	airway pressure	intraoperative

Collaborators and Investigators

• Sponsor: Rambam Health Care Campus

Publications and helpful links

General Publications

• Kremer R, Aboud W, Haberfeld O, Armali M, Barak M. Differential lung ventilation for increased oxygenation during one lung ventilation for video assisted lung surgery. J Cardiothorac Surg. 2019 May 6;14(1):89. doi: 10.1186/s13019-019-0910-2.

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2017
• Primary Completion (Actual): September 30, 2017
• Study Completion (Actual): September 30, 2017

Study Registration Dates

• First Submitted: May 26, 2018
• First Submitted That Met QC Criteria: June 9, 2018
• First Posted (Actual): June 20, 2018

Study Record Updates

• Last Update Posted (Actual): June 20, 2018
• Last Update Submitted That Met QC Criteria: June 9, 2018
• Last Verified: June 1, 2018

More Information

Terms related to this study

• Keywords: continuous positive airway pressure; one lung ventilation; differential lung ventilation
• Other Study ID Numbers: RMB-0032-16

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No