- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04260451
Driving Pressure and Postoperative Pulmonary Complications in Thoracic Surgery
Comparison of Postoperative Pulmonary Complications Between Driving Pressure Guided Ventilation and Conventional Protective Ventilation in Thoracic Surgery
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Nowdays, the usual setting of protective ventilation during one lung ventilation is tidal volume (VT) 5 ml/kg of predicted body weight, positive end-expiratory pressure (PEEP) 5 cm H2O and plateau pressure (Pplat) less than 25 cmH2O.
However, a high incidence of postoperative pulmonary complications is still being observed even with a protective ventilatory strategy.
Driving pressure is [Pplat - PEEP] and is the pressure required for the alveolar opening. Static lung compliance (Cstat) is expressed as [VT / (Pplat - PEEP)]. Thus, driving pressure is also expressed as [VT / Cstat]. Driving pressure has an inverse relationship with Cstat and orthodromic relationship with VT according to this formula. High driving pressure indicates poor lung condition with decreased lung compliance.
Thus, investigator try to prove that driving pressure limited ventilation is superior in preventing postoperative pulmonary complications to existing protective ventilation in large scale multicenter study.
Recruit maneuver perform all group after intubation (stepwise increase of positive end expiratory pressure 5,10,15 cmH2O with tidal volume 5mL/kg).
The control arm receives existing conventional protective ventilation with tidal volume of 5mL/kg of ideal body weight and PEEP of 5 cmH2O during one-lung ventilation.
The driving pressure arm receives driving pressure limited ventilation with tidal volume of 5mL/kg of ideal body weight and individualized PEEP. Individualized PEEP is adjusted to minimize driving pressure, it find through decremental PEEP titration from 10 to 2 cmH2O during one-lung ventilation.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Seoul, Korea, Republic of, 06351
- Samsung Medical Center
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
Adults older than or equal to 19 years with American Society of Anesthesiologists physical status Ⅰ-Ⅲ Patient who undergoes one-lung ventilation (more than 60 minutes) for elective thoracic surgery
Exclusion Criteria:
- The American Society of Anesthesiologists (ASA) Physical Status classification greater than or equal to 4
- Symptoms of heart failure (hypertension, urination, pulmonary edema, left ventricular outflow rate <45%) or preoperative vasopressors
- Patient who is received oxygen therapy and ventilation care
- large emphysema and pneumothorax
- pregnancy and lactation
- patients participating in similar studies
- Joint with other operation
- Patient who rejects being enrolled in the study
- Patients with elevated intracranial pressure
- Patients with peripheral neuropathy or blood circulation disorders
- Patients with hematology disease
- Congenital heart disease with shunt
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 |
---|---|
Experimental: Driving pressure group
Positive end expiratory pressure is adjusted to tidal volume of 5 mL/kg of ideal body weight, inspiratory:expiratory=1:2, and minimize driving pressure (plateau pressure minus end expiratory pressure) during one-lung ventilation.
Other procedures are same with the control arm.
|
Driving Pressure Limited Ventilation Positive end expiratory pressure is adjusted to minimize driving pressure, plateau pressure minus end expiratory pressure from 10 to 2 cmH2O during one-lung ventilation. 1. Lung recruitment: stepwise increase of positive end expiratory pressure 5,10,15 cmH2O with tidal volume 5mL/kg, inspiratory:expiratory 1:1, respiratory rate 10. and driving pressure up to 20 cmH2O. Then decremental PEEP titration is performed using a volume-controlled ventilation until the lowest driving pressure (plateau pressure minus PEEP) is found. This individualized PEEP is adjusted during one-lung ventilation. |
No Intervention: Protective Ventilation
The control arm receives existing conventional protective ventilation with tidal volume of 5mL/kg of ideal body weight and positive end expiratory pressure of 5cmH2O during one-lung ventilation
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
the incidence of postoperative pulmonary complications
Time Frame: within the first 7 days after surgery
|
Postoperative pulmonary complications are defined as one or more of the following:
|
within the first 7 days after surgery
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
oxygenation
Time Frame: 15 minutes after one-lung ventilation
|
Partial pressure of oxygen in arterial blood (PaO2, mmHg) or PaO2/Inspired oxygen fraction (PF ratio)
|
15 minutes after one-lung ventilation
|
the incidence of rescue ventilation
Time Frame: during surgery
|
the need for rescue ventilation to treat hypoxia (Inspired oxygen fraction 1.0, two lung ventilation, recruitment, PEEP change, Tidal volume change, continuous positive pressure ventilation, change to pressure control mode)
|
during surgery
|
Cstat
Time Frame: 15 minutes after one-lung ventilation
|
Lung compliance (mL/mmHg)
|
15 minutes after one-lung ventilation
|
CRP
Time Frame: within the first 1 days after surgery
|
C-reactive protein (mg/L) of laboratory exam
|
within the first 1 days after surgery
|
the incidence of postoperative transfusion
Time Frame: within the first 3 days after surgery
|
red blood cell, fresh frozen plasma, platelet
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within the first 3 days after surgery
|
the incidence of postoperative renal complications
Time Frame: within the first 7 days after surgery
|
acute kidney injury(acute kidney injury network criteria): Stage I: Diuresis < 0.5 mg/kg (6 h) or increase in serum Cr > 0.3 mg/dl.
Stage II: Diuresis < 0.5 mg/kg (12 h) or basal Cr x 2 mg/dL.
Stage III: Diuresis < 0.3 mg/kg (24 h) or anuria (12 h) or basal Cr x 3 mg/dL, or Cr > 4 mg/dL or renal replacement therapy.
|
within the first 7 days after surgery
|
the incidence of postoperative cognitive complications
Time Frame: within the first 7 days after surgery
|
diagnosed by Confusion Assessment method (CAM: positive or negative) or Medicines for treating delirium symptoms include antipsychotic drugs and benzodiazepines
|
within the first 7 days after surgery
|
the incidence of postoperative surgical site complications
Time Frame: within the first 7 days after surgery
|
: The CDC defines a superficial incisional surgical site infection as one which meets the following criteria.
|
within the first 7 days after surgery
|
the incidence of acute myocardial infarction
Time Frame: within the first 7 days after surgery
|
Acute myocardial injury with clinical evidence of acute myocardial ischemia and with detection of a rise and/or fall of cardiac troponin values with at least one value above the 99th percentile upper reference limit and at least one of the following:
|
within the first 7 days after surgery
|
the incidence of coronary thrombosis
Time Frame: within the first 7 days after surgery
|
Percutaneous coronary intervention or coronary artery surgery
|
within the first 7 days after surgery
|
the incidence of cerebral infarction
Time Frame: within the first 7 days after surgery
|
Magnetic resonance imaging diagnosis
|
within the first 7 days after surgery
|
the incidence of septic shock
Time Frame: within the first 7 days after surgery
|
: A subset of sepsis (a life-threatening organ dysfunction resulting from dysregulated host responses to infection) in which underlying circulatory, cellular, and metabolic abnormalities are profound enough to substantially increase the risk of mortality.
Despite adequate fluid resuscitation, patients have hypotension requiring vasopressors to maintain a mean arterial blood pressure above 65 mmHg and have an elevated serum lactate concentration of more than 2 mmol/L
|
within the first 7 days after surgery
|
the incidence of new arrythmia
Time Frame: within the first 7 days after surgery
|
New arrhythmias that persist for more than 2 days
|
within the first 7 days after surgery
|
Length of stay in the intensive care unit and hospital
Time Frame: within the first 30 days after surgery
|
the duration of hospital stay and intensive care unit stay (day)
|
within the first 30 days after surgery
|
the incidence of re-admission
Time Frame: within the first 30 days after surgery
|
re-admission because of surgical related problems
|
within the first 30 days after surgery
|
mortality
Time Frame: within the first 30 days after surgery
|
in hospital death or out of hospital
|
within the first 30 days after surgery
|
Collaborators and Investigators
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
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
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- SMC2019-07-182-009
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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