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Cerebral Oximetry-Guided Low FiO2 Strategies in Thoracic Surgery.

16. juni 2026 opdateret af: Ayhan Kaydu, Dicle University

Safety and Efficacy of Cerebral Oximetry-Guided Low FiO2 Strategies in Thoracic Surgery

Brief Summary (Kısa Özet)The purpose of this study is to evaluate the safety and efficacy of a cerebral oximetry-guided low fraction of inspired oxygen (FiO_2) ventilation strategy compared to a standard high FiO_2 strategy in patients undergoing elective thoracic surgery requiring one-lung ventilation (OLV).Oxygen toxicity and related postoperative pulmonary complications remain significant risks during thoracic anesthesia. While standard protocols often rely on high inspired oxygen concentrations to maintain peripheral oxygen saturation (SpO_2), this approach may induce hyperoxia. Conversely, lowering FiO_2 arbitrarily can increase the risk of hypoxemia or compromise tissue oxygenation. This prospective, parallel-group, 1:1 randomized, single-blind clinical trial aims to safely reduce intraoperative oxygen exposure by using regional cerebral oxygen saturation (rSO_2) monitoring as a physiological guide.A total of 60 participants aged 18 and older, classified as ASA I-III and scheduled for elective thoracic surgery, will be randomly assigned to one of two arms:Experimental Group (Guided Low FiO_2 Strategy): Ventilation will be initiated at a low FiO_2 of 0.5. The FiO_2 level will not be increased unless peripheral saturation (SpO_2) falls below 90% or cerebral oxygenation (rSO_2) drops below 80% of the patient's baseline value.Active Comparator Group (Standard Strategy): Patients will receive conventional anesthesia management, maintaining standard high FiO_2 levels to keep SpO_2 above 90% without cerebral oximetry guidance.The primary outcomes to be measured are the incidence of cerebral desaturation during the perioperative period and the incidence of postoperative delirium assessed via the 3D-CAM tool until hospital discharge. Secondary outcomes include intraoperative hemodynamic stability, arterial blood gas parameters (PaO_2, PaCO_2, pH, lactate), incidence of hypoxemia, total one-lung ventilation duration, postoperative cognitive dysfunction (POCD), and lengths of stay in both the intensive care unit (ICU) and the hospital.By utilizing real-time non-invasive cerebral oximetry, the study intends to demonstrate a safe ventilation protocol that minimizes oxygen toxicity without compromising cerebral oxygenation or clinical recovery outcomes.

Studieoversigt

Status

Ikke rekrutterer endnu

Betingelser

Intervention / Behandling

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

60

Fase

  • Ikke anvendelig

Kontakter og lokationer

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Studiekontakt

  • Navn: Ayhan Kaydu, associate professor
  • Telefonnummer: +90 505 556 7939
  • E-mail: akaydu@hotmail.com

Studiesteder

    • Eyalet/Yerleşke
      • Diyarbakır, Eyalet/Yerleşke, Tyrkiet (Türkiye), 21070
        • Dicle University
        • Kontakt:

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Berettigelseskriterier

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Beskrivelse

Inclusion Criteria:

  • Patients aged 18 years or older. Scheduled for elective thoracic surgery requiring one-lung ventilation (OLV). American Society of Anesthesiologists (ASA) Physical Status classification I-III.

Exclusion Criteria:

  • History of cerebrovascular disease. Left ventricular ejection fraction Pulmonary hypertension. Interstitial lung disease.

Renal failure. Neuromuscular disease. Pregnancy. Expected OLV duration less than 30 minutes (< 30 min)

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Diagnostisk
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Enkelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Low FiO2 Group
Patients undergoing elective thoracic surgery managed with a cerebral oximetry-guided low FiO_2 ventilation strategy
Following general anesthesia induction, the initial $FiO_2$ will be set to 0.5. $FiO_2$ will not be increased unless the patient's pulse oximetry ($SpO_2$) drops below 90% or regional cerebral oxygen saturation ($rSO_2$) drops below 80% of its baseline value
Aktiv komparator: Standard Group
Patients undergoing elective thoracic surgery managed with a standard conventional ventilation strategy
Patients receive the standard institutional anesthesia protocol where $SpO_2$ values are strictly maintained above 90%

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Incidence of Postoperative Delirium
Tidsramme: Postoperative days 1 to 3 (up to hospital discharge)
Assessed using the 3D-CAM (Confusion Assessment Method) test
Postoperative days 1 to 3 (up to hospital discharge)
Incidence of Cerebral Desaturation
Tidsramme: Perioperative period (from anesthesia induction to end of surgery, approximately up to 4 hours)
Cerebral desaturation monitored via near-infrared spectroscopy (rSO₂, %)
Perioperative period (from anesthesia induction to end of surgery, approximately up to 4 hours)

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Incidence of Hypoxemia
Tidsramme: During one-lung ventilation (OLV), approximately up to 2 hours
Incidence of hypoxemia defined as SpO₂ < 90% during one-lung ventilation (%)
During one-lung ventilation (OLV), approximately up to 2 hours
Mean Fraction of Inspired Oxygen (FiO₂)
Tidsramme: During one-lung ventilation (OLV), approximately up to 2 hours
Mean FiO₂ levels required to maintain adequate oxygenation during one-lung ventilation
During one-lung ventilation (OLV), approximately up to 2 hours
Mean Arterial Pressure (MAP)
Tidsramme: Intraoperative period, approximately up to 4 hours
Intraoperative mean arterial pressure changes monitored via standard non-invasive or invasive blood pressure measurement (mmHg)
Intraoperative period, approximately up to 4 hours
Heart Rate (HR)
Tidsramme: Intraoperative period, approximately up to 4 hours
Intraoperative heart rate changes monitored via standard ECG (beats per minute)
Intraoperative period, approximately up to 4 hours

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Sponsor

Datoer for undersøgelser

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Studer store datoer

Studiestart (Anslået)

15. juni 2026

Primær færdiggørelse (Anslået)

1. august 2026

Studieafslutning (Anslået)

15. august 2026

Datoer for studieregistrering

Først indsendt

11. juni 2026

Først indsendt, der opfyldte QC-kriterier

16. juni 2026

Først opslået (Faktiske)

22. juni 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

22. juni 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

16. juni 2026

Sidst verificeret

1. juni 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • 74/2026

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