Unilateral Ventilation on Cardiopulmonary Bypass During Cardiac Surgery
Unilateral Ventilation on Cardiopulmonary Bypass During Cardiac Surgery in Patients at Increased Risk for Severe Postoperative Pulmonary Complications
Studienübersicht
Status
Status
Bedingungen
Bedingungen
- Herz-Lungen-Bypass
- Lungen-Ultraschall
- Elektrische Impedanztomographie (EIT)
- Einlungenbeatmung
- Lungenprotektive Beatmung
- Beurteilung des Lungenwassers
- Lungen-Compliance
- Röntgenaufnahme der Brust zur klinischen Beurteilung
- Lungenkomplikationen bei chirurgischen Patienten
- Biomarker der vaskulären endothelialen Verletzung
- Oxygenierungsindizes
- Hochrisiko-Herzpatienten
Intervention / Behandlung
Intervention / Behandlung
Studientyp
Studientyp
Einschreibung (Geschätzt)
Einschreibung
Phase
Phase
- Unzutreffend
Kontakte und Standorte
Studienkontakt
Studienkontakt
- Name: Martin Dworschak, MD, MBA
- Telefonnummer: 41090 +43-1-40400
- E-Mail: martin.dworschak@meduniwien.ac.at
Studieren Sie die Kontaktsicherung
- Name: Edda M. Tschernko, MD, MBA
- Telefonnummer: 41060 +43-1-40400
- E-Mail: edda.tschernko@meduniwien.ac.at
Studienorte
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State of Vienna
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Vienna, State of Vienna, Österreich, 1090
- General hospital Vienna
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Kontakt:
- Martin Dworschak, MD, MBA
- Telefonnummer: 41090 +43-1-40400
- E-Mail: martin.dworschak@meduniwien.ac.at
-
Kontakt:
- Edda M. Tschernko, MD, MBA
- Telefonnummer: 41060 +43-1-40400
- E-Mail: edda.tschernko@meduniwien.ac.at
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Hauptermittler:
- Martin Dworschak, MD, MBA
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Unterermittler:
- Edda M. Tschernko, MD, MBA
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Unterermittler:
- Keso Skhirtladze-Dworschak, MD
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Unterermittler:
- Florentina Zingher, MD
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Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
- Älterer Erwachsener
Akzeptiert gesunde Freiwillige
Beschreibung
Inclusion Criteria:
- Patients at increased risk for postoperative pulmonary complications
- Major elective cardiac surgery
- Prolonged duration of cardiopulmonary bypass
- Patients older than 65 years of age
- Informed consent
Exclusion Criteria:
- Emergency
- Urgent procedures
- Patients with implanted pacemakers
- Patients with internal cardioverter/defibrillators
- Decompensated cardiac disease
- Pulmonary disease
- Recent pneumonia
- Need for temporary perioperative mechanical support
- Patients not willing to participate
- Treatment with inhaled nitric oxide
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Unterstützende Pflege
- Zuteilung: N / A
- Interventionsmodell: Einzelgruppenzuweisung
- Maskierung: Keine (Offenes Etikett)
Anzahl der Arme
Waffen und Interventionen
Teilnehmergruppe / ArmTeilnehmergruppe / Arm |
Intervention / BehandlungIntervention / Behandlung |
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Aktiver Komparator: Risk group
Lung ventilated during cardiopulmonary bypass using single-lung ventilation via double-lumen tube.
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This lung will be ventilated during cardiopulmonary bypass using volume-controlled ventilation with a tidal volume of 3 mL/kg ideal body weight, a PEEP of 5 cmH2O, a respiratory rate of 10/min, and a fraction of inspired oxygen of 30%.
The contralateral lung will not be ventilated during cardiopulmonary bypass and will be allowed to collapse.
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Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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Lung aeration score of both lungs.
Zeitfenster: Lung ultrasound investigations will be performed at baseline, i.e., before surgery, on the day of surgery, and on day 1 and 2 after surgery in the intensive care unit.
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The aeration score of each lung is the sum of the aeration scores determined in each of six lung quadrants in each lung, which can range from 0 (normal ventilation) to 3 (atelectasis/consolidation).
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Lung ultrasound investigations will be performed at baseline, i.e., before surgery, on the day of surgery, and on day 1 and 2 after surgery in the intensive care unit.
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Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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Radiologic assessment of Kerley B lines as indicators of lung edema.
Zeitfenster: Performed on the day of surgery and on day 1 and 2 after surgery on the intensive care unit.
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Number of Kerley B lines in both lungs determined by chest x-ray where stage 1 (no Kerley B lines) reflects best outcome, stage 2 (Kerley B lines become visible) indicates interstitial edema, and stage 3 (increased number of Kerley B lines also in non-dependent areas and partially obscured in dependent parts of the lung) are a sign of alveolar edema.
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Performed on the day of surgery and on day 1 and 2 after surgery on the intensive care unit.
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Presence of pleural effusion in chest x-ray.
Zeitfenster: Performed on the day of surgery and on day 1 and 2 after surgery on the intensive care unit.
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Severity assessment will be semi-quantitative with 0 = no effusion, 1 = small effusion (with blunting of the basal lung segments and the costophrenic angle), 2 = moderate effusion (fluid extents to the mid-hemithorax creating a "meniscus sign"), and 3 = massive effusion (the whole lung appears opaque with displacement of the heart to the contralateral side if located unilaterally).
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Performed on the day of surgery and on day 1 and 2 after surgery on the intensive care unit.
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Determination of the Global Inhomogeneity (GI) index in both lungs separately by thoracic Electrical Impedance Tomography (EIT).
Zeitfenster: On the day of surgery and on day 1 and 2 after surgery in the intensive care unit.
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Global inhomogeneity is calculated as the sum of the absolute differences between the median value of tidal variation and every single pixel value, divided by the sum of all impedance values, to normalize the calculated values.
A GI index closer to 0 represents highly homogeneous (even) ventilation.
Higher values (i.e., > 0.5) indicate that some parts of the lung are over-distended while others are poorly aerated or collapsed (atelectasis).
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On the day of surgery and on day 1 and 2 after surgery in the intensive care unit.
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Worst oxygenation (Horowitz) index measured per day during routine blood gas checks.
Zeitfenster: Assessed on the day of surgery and on day 1 and 2 after surgery.
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The Horowitz index (HI) is calculated by diving arterial oxygen partial pressure determined in the blood gas by the fraction of inspired oxygen.
It will be assessed after each blood gas check and the lowest HI during one day will be entered for further statistical analysis.
The degree of impaired lung function will be determined as follows: HI > 300 mmHg (healthy lung function), HI between 201-300 mmHg (mild lung injury), HI between 101-200 mmHg (moderately severely impaired lung function), and HI < 100 mmHg (severe lung injury, ARDS).
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Assessed on the day of surgery and on day 1 and 2 after surgery.
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Static lung compliance determined in each lung separately.
Zeitfenster: On the day of surgery in the operating room before and after cardiac surgery on cardiopulmonary bypass when the patient is still ventilated via double lumen tube.
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Static lung compliance of the ventilated and the non-ventilated lung will be determined twice for each patient.
Static compliance in healthy adults ranges between 60 and 100 mL/cm H₂O.
Values below 50 mL/cm H₂O would be considered abnormally low.
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On the day of surgery in the operating room before and after cardiac surgery on cardiopulmonary bypass when the patient is still ventilated via double lumen tube.
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Amount of released immune modulators.
Zeitfenster: Determined on the day of surgery as well as on day 1, 2, 3, and 4 after surgery.
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Serum levels for HSP70, MMP-8, MMP-9, TIMP-1, and Lipocalin-2 will be determined in patients' blood samples, with normal values ranging from 0.2-3 ng/mL for HSP70, 0.3-1.2
ng/mL for MMP-8, 14-100 ng/mL for MMP-9, 80-150 ng/mL for TIMP-1, and 20-130 ng/mL for Lipocalin-2, respectively.
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Determined on the day of surgery as well as on day 1, 2, 3, and 4 after surgery.
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Andere Ergebnismessungen
Andere Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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Length of ICU and hospital stay.
Zeitfenster: These variables will be censored at study completion, on average 30 days.
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The duration from transfer to the intensive care unit until discharge to a step-down unit and the duration of hospitalization of the patient will be determined in days.
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These variables will be censored at study completion, on average 30 days.
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In-hospital mortality.
Zeitfenster: In-hospital mortality will be censored at study completion, on average 30 days.
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It will be recorded if the patient has been discharged from the hospital alive.
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In-hospital mortality will be censored at study completion, on average 30 days.
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Duration on respiratory support via endotracheal tube.
Zeitfenster: The time until extubation will be censored at study completion, on average 30 days.
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The hours between arrival of the intubated patient on the intensive care unit until extubation will be determined.
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The time until extubation will be censored at study completion, on average 30 days.
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Postoperative complications.
Zeitfenster: All complications will be censored at study completion, on average 30 days.
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Any complication that poses a risk for the patient occurring during the hospital stay and having been documented in the patient's file will be retrieved by carefully reviewing the files and recorded.
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All complications will be censored at study completion, on average 30 days.
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Mitarbeiter und Ermittler
Sponsor
Sponsor
Ermittler
Ermittler
- Hauptermittler: Martin Dworschak, MD, MBA, Medical University of Vienna
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Geschätzt)
Studienbeginn
Primärer Abschluss (Geschätzt)
Primärer Abschluss
Studienabschluss (Geschätzt)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- EK Nr: 1250/2021
Plan für individuelle Teilnehmerdaten (IPD)
Planen Sie, individuelle Teilnehmerdaten (IPD) zu teilen?
Beschreibung des IPD-Plans
Arzneimittel- und Geräteinformationen, Studienunterlagen
Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt
Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt
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