Evaluation of the Effects of Different Ventilation Modes Used During Anesthesia Awakening on the Frequency of Postoperative Atelectasis

Evaluation of the Effects of Different Ventilation Modes Used During Anesthesia Awakening on the Frequency of Postoperative Atelectasis by Lung Ultrasonography: A Prospective Observational Study

In our study, we aimed to detect atelectasis developing in patients undergoing surgery under general anesthesia using transthoracic lung ultrasonography and to investigate the effect of ventilation methods used during recovery from anesthesia on the formation of postoperative atelectasis.

Study Overview

• Status: Not yet recruiting
• Conditions: Atelectasis, Postoperative Pulmonary
• Intervention / Treatment: Diagnostic test: lung ultrasound

Detailed Description

Postoperative atelectasis is one of the most common pulmonary complications seen in surgical patients. Postoperative pulmonary complications and possible respiratory side effects have long been associated with anesthesia. Pulmonary complications are an important cause of morbidity and mortality in the postoperative period. The incidence of postoperative pulmonary complications due to long-term anesthesia varies between 5% and 80%, depending on the patient population, the surgery performed, and the criteria used to define the complication. It is known that the recovery period makes a significant contribution to the total amount of postoperative atelectasis. Spontaneously breathing patients are under the influence of anesthetic agents and neuromuscular blockers and cannot regain their functional residual capacity. For this reason, it is emphasized that atelectasis may develop in the postoperative period in cases whose anesthesia application is terminated by applying a spontaneous breathing period. Pressure support ventilation (PSV) is widely used for ventilator weaning in the intensive care unit (ICU) and has recently been available on anesthesia machines.

It is expected that the use of lung ultrasonography in operating rooms can reduce the complications that may develop in the postoperative period with evidence-based detection and early postoperative detection of atelectasis in the early postoperative period.

In this study, it was aimed to compare the effect of pre-extubation ventilation mode applied by anesthesia practitioners with ultrasound in the postoperative period on the frequency of atelectasis in adult patients who underwent surgery and whose lungs were evaluated as normal by ultrasound in the preoperative observation room. Modified LUS scores were used as lung ultrasonography evaluation criteria in the study.

• Study Type: Observational
• Enrollment (Estimated): 278

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

The patients 18 years of age or older and American Society of Anesthesiologists (ASA) physical status I and III who were scheduled for general anesthesia were included in this prospective observational study.

Description

Inclusion Criteria:

• Patients undergoing general anesthesia with supine position
• Endotracheal intubations and mechanical ventilation during general anesthesia
• Operation time is more than 2 hours

Exclusion Criteria:

• Patients who will undergo surgical intervention under emergency conditions
• Pregnancy
• Upper respiratory tract disease in the last 3 weeks
• Previous lung surgery
• Advanced cardiac and/or pleural lung disease and chest wall deformity, and primary or metastatic lung cancer

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
pressure support ventilation group; when the patients were ready for extubation, anesthesia was terminated by one of the selected pressure support ventilation	Diagnostic test: lung ultrasound; The patients included in the study underwent lung imaging with lung ultrasound score twice, in the preoperative preparation room and in the postoperative recovery unit.Both lungs were determined as anterior and posterior axillary lines as anatomical markers and divided into a total of 12 regions, 4 in the anterior thoracic wall, 4 in the lateral wall, and 4 in the posterior region. In our study, we will use the modified LUS scoring, which has been shown to be more sensitive in the diagnosis of postoperative atelectasis in the recovery unit, based on existing literature reviews. The degree of the atelectasis will be determined according to do modified lung ultrasound score. Lung ultrasound score imaging of all patients was performed by the same anesthesiologist.; Other Names: Modified Transthoracic Ultrasound Scoring System
manual ventilation group; when the patients were ready for extubation, anesthesia was terminated by one of the selected manual ventilation wake-up methods at the initiative of the relevant anesthesiologist.	Diagnostic test: lung ultrasound; The patients included in the study underwent lung imaging with lung ultrasound score twice, in the preoperative preparation room and in the postoperative recovery unit.Both lungs were determined as anterior and posterior axillary lines as anatomical markers and divided into a total of 12 regions, 4 in the anterior thoracic wall, 4 in the lateral wall, and 4 in the posterior region. In our study, we will use the modified LUS scoring, which has been shown to be more sensitive in the diagnosis of postoperative atelectasis in the recovery unit, based on existing literature reviews. The degree of the atelectasis will be determined according to do modified lung ultrasound score. Lung ultrasound score imaging of all patients was performed by the same anesthesiologist.; Other Names: Modified Transthoracic Ultrasound Scoring System

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Modified Transthoracic Ultrasound Score	Both lungs were determined as anterior and posterior axillary lines as anatomical markers and divided into a total of 12 regions, 4 in the anterior thoracic wall, 4 in the lateral wall, and 4 in the posterior region. While the anterior and lateral regions were examined in the supine position by placing the probe perpendicular to the thoracic wall and longitudinal in the intercostal spaces with the bat sign displayed, especially the posterior regions close to the diaphragm were examined by placing the probe transversely in the intercostal spaces by turning the patient opposite. According to the systematic LUS protocol, each patient was evaluated for approximately 10-15 minutes and optimum images were obtained.Each area was scored on a scale of 0-3 according to the degree of atelectasis, and a total score between 0 (normal lung ventilation image) and 36 (total loss of ventilation) was calculated.	two weeks

Collaborators and Investigators

• Sponsor: Dokuz Eylul University

Study record dates

Study Major Dates

• Study Start (Estimated): April 5, 2024
• Primary Completion (Estimated): April 21, 2024
• Study Completion (Estimated): April 30, 2024

Study Registration Dates

• First Submitted: April 5, 2024
• First Submitted That Met QC Criteria: April 5, 2024
• First Posted (Actual): April 10, 2024

Study Record Updates

• Last Update Posted (Actual): April 10, 2024
• Last Update Submitted That Met QC Criteria: April 5, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: Postoperative Pulmonary Complications; Atelectasis; Pressure Support Ventilation; Lung Ultrasonography
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Lung Diseases; Pulmonary Atelectasis
• Other Study ID Numbers: DokuzEU-ACC-BOtlu-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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