How To Prevent Ventilator-Related Lung Damage in Intraoperative Mechanical Ventilation? Pcv or Vcv ?

Introduction: Intraoperative Mechanical Ventilation practices can lead to ventilator-associated lung injury (VILI) and postoperative pulmonary complications in healthy lungs. Mechanical Power has been developed as a new concept in reducing the risk of postoperative pulmonary complications as it takes into account all respiratory mechanics that cause VILI formation. Volume control mode is at the forefront in the old anesthesia devices used in the operating room, and today, together with technology, there are anesthesia devices with many modes and features, as in intensive care units. This causes confusion in the use of mechanical ventilators. In this study, volume and pressure control ventilation modes were compared in terms of respiratory mechanics (including mechanical power) in patients operated in the supine and prone positions.

Aim of study: It has been compared the effects on postoperative pulmonary complications (PPH) in terms of VILI risk by calculating mechanical power from advanced respiratory mechanics of patients ventilated in pressure and volume control modes, which are frequently used in operating room applications.

Conclusion: There was no statistically significant difference between the groups in terms of demographic data, ariscat score, and ariscat risk group values. The supine and prone mechanical power (MPrs) values of the volume control group were statistically significantly lower than the pressure control group. P values were calculated as 0.012 and 0.001, respectively.

Results: Supine and prone MPrs values of the volume control group were calculated significantly lower than the pressure control group. Pressure-controlled intraoperative mechanical ventilation is considered to be disadvantageous in terms of the risk of VILI in the supine and prone position in terms of the current mechanical power concept.

Study Overview

• Status: Completed
• Conditions: Postoperative Complications; Ventilator-Induced Lung Injury; Mechanical Ventilation Complication; Ventilator Lung
• Intervention / Treatment: Procedure: Position/Ventilation

Detailed Description

Although mechanical ventilation is a life-saving intervention, it can lead to ventilator-induced lung injury (VILI). VILI is the damage caused by positive pressure ventilation that starts with the use of mechanical ventilators. There are many factors that cause VILI such as tidal volume, drive pressure, flow, respiratory rate, and PEEP. Mechanical power, which collects these different variables in a single parameter, offers us new possibilities in predicting VILI at the bedside. The mechanical power being above a certain threshold causes damage ranging from pulmonary parenchymal rupture to severe inflammation and edema. Also, higher mechanical power values are associated with higher mortality. The protective ventilation strategy in intensive care units is also applied in operating rooms (OR) to minimize the risk of postoperative pulmonary complications due to VILI. While the volume control mode was at the forefront in the old anesthesia devices used in the OR, today there are anesthesia devices with many modes and features, as in intensive care units. This causes confusion in the use of mechanical ventilators in the perioperative period. Therefore, in this study, the investigators compared the perioperative mechanical power values in prone and supine positions, and postoperative pulmonary complications of two ventilation modes (volume control-pressure control ventilation). Thus, the investigators aimed to find out which ventilation mode would be advantageous in the perioperative period.

• Study Type: Observational
• Enrollment (Actual): 80

Contacts and Locations

Study Locations

• Turkey
  • Istanbul, Turkey
    • Basaksehir Cam Sakura City Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Cervical hernia, lumbar hernia and lumbar stabilization cases who were operated in the neurosurgery operating room of the anesthesia and reanimation clinic were examined.

Description

Inclusion Criteria:

• ASA I - III risk group patients
• Patients between the ages of 18-70
• At least 2 hours of mechanical ventilation time

Exclusion Criteria:

• Patients with COPD or Asthma bronchial
• Patients with a functional capacity of less than 7 METS
• Pregnant and lactating female patients.
• Patients who have had thoracic surgery before
• Patients with BMI above 35
• Patients who had hemodynamic instability or desaturation (SpO2<92%) during the operation

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Pressure Control Ventilation Supine Group; 20 patients were ventilated in the supine position with pressure control mode.	Procedure: Position/Ventilation; Positioning and ventilation mode adjustments were made to the patients.
Pressure Control Ventilation Prone Group; 20 patients were ventilated in the prone position with pressure control mode.	Procedure: Position/Ventilation; Positioning and ventilation mode adjustments were made to the patients.
Volume Control Ventilation Supine Group; 20 patients were ventilated in the supine position with volume control mode.	Procedure: Position/Ventilation; Positioning and ventilation mode adjustments were made to the patients.
Volume Control Ventilation Prone Group; 20 patients were ventilated in the prone position with volume control mode.	Procedure: Position/Ventilation; Positioning and ventilation mode adjustments were made to the patients.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mechanical power	Mechanical power values calculated during surgery were compared.	During surgery (2 hours to 4 hours)
Postoperative complications	Postoperative pulmonary complications were observed.	Postoperative period (up to 10 days)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Respiratory parameters other than mechanical power	PEEP(mmHg) value measured during surgery were compared.	During surgery (2 hours to 4 hours)
Respiratory parameters other than mechanical power	Tidal volume(ml) value measured during surgery were compared.	During surgery (2 hours to 4 hours)
Respiratory parameters other than mechanical power	Peak pressure(mmHg) value measured during surgery were compared.	During surgery (2 hours to 4 hours)
Respiratory parameters other than mechanical power	Plato pressure(mmHg) value measured during surgery were compared.	During surgery (2 hours to 4 hours)
Respiratory parameters other than mechanical power	Driving pressure(mmHg) value measured during surgery were compared.	During surgery (2 hours to 4 hours)
Respiratory parameters other than mechanical power	Inspiratory time(second) value measured during surgery were compared.	During surgery (2 hours to 4 hours)

Collaborators and Investigators

• Sponsor: Basaksehir Cam & Sakura Şehir Hospital
• Investigators: Study Director: Furkan Tontu, Basaksehir Cam Sakura City Hospital

Publications and helpful links

General Publications

• Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013 Nov 28;369(22):2126-36. doi: 10.1056/NEJMra1208707. No abstract available. Erratum In: N Engl J Med. 2014 Apr 24;370(17):1668-9.
• Gattinoni L, Tonetti T, Cressoni M, Cadringher P, Herrmann P, Moerer O, Protti A, Gotti M, Chiurazzi C, Carlesso E, Chiumello D, Quintel M. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016 Oct;42(10):1567-1575. doi: 10.1007/s00134-016-4505-2. Epub 2016 Sep 12.
• Cressoni M, Gotti M, Chiurazzi C, Massari D, Algieri I, Amini M, Cammaroto A, Brioni M, Montaruli C, Nikolla K, Guanziroli M, Dondossola D, Gatti S, Valerio V, Vergani GL, Pugni P, Cadringher P, Gagliano N, Gattinoni L. Mechanical Power and Development of Ventilator-induced Lung Injury. Anesthesiology. 2016 May;124(5):1100-8. doi: 10.1097/ALN.0000000000001056.
• Tonetti T, Vasques F, Rapetti F, Maiolo G, Collino F, Romitti F, Camporota L, Cressoni M, Cadringher P, Quintel M, Gattinoni L. Driving pressure and mechanical power: new targets for VILI prevention. Ann Transl Med. 2017 Jul;5(14):286. doi: 10.21037/atm.2017.07.08.
• Giosa L, Busana M, Pasticci I, Bonifazi M, Macri MM, Romitti F, Vassalli F, Chiumello D, Quintel M, Marini JJ, Gattinoni L. Mechanical power at a glance: a simple surrogate for volume-controlled ventilation. Intensive Care Med Exp. 2019 Nov 27;7(1):61. doi: 10.1186/s40635-019-0276-8.
• Asar S, Acicbe O, Cukurova Z, Hergunsel GO, Canan E, Cakar N. Bedside dynamic calculation of mechanical power: A validation study. J Crit Care. 2020 Apr;56:167-170. doi: 10.1016/j.jcrc.2019.12.027. Epub 2020 Jan 2.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2021
• Primary Completion (Actual): May 1, 2021
• Study Completion (Actual): June 1, 2021

Study Registration Dates

• First Submitted: March 16, 2023
• First Submitted That Met QC Criteria: April 3, 2023
• First Posted (Actual): April 14, 2023

Study Record Updates

• Last Update Posted (Actual): April 14, 2023
• Last Update Submitted That Met QC Criteria: April 3, 2023
• Last Verified: April 1, 2023

More Information

Terms related to this study

• Keywords: supine; mechanical power; postoperative pulmonary complications; prone
• Additional Relevant MeSH Terms: Pathologic Processes; Respiratory Tract Diseases; Lung Diseases; Wounds and Injuries; Thoracic Injuries; Postoperative Complications; Lung Injury; Ventilator-Induced Lung Injury
• Other Study ID Numbers: 21-20-07

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Not decided yet.

Drug and device information, study documents

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