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
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
- Bypass cardiopolmonare
- Ultrasuoni polmonari
- Tomografia ad impedenza elettrica (EIT)
- Ventilazione monopolmone
- Ventilazione protettiva polmonare
- Valutazione dell'acqua polmonare
- Conformità polmonare
- Radiografia del torace per la valutazione clinica
- Complicanze polmonari nei pazienti chirurgici
- Biomarcatori della lesione endoteliale vascolare
- Indici di ossigenazione
- Pazienti Cardiaci ad Alto Rischio
Intervento / Trattamento
Intervento / Trattamento
Tipo di studio
Tipo di studio
Iscrizione (Stimato)
Iscrizione
Fase
Fase
- Non applicabile
Contatti e Sedi
Contatto studio
Contatto studio
- Nome: Martin Dworschak, MD, MBA
- Numero di telefono: 41090 +43-1-40400
- Email: martin.dworschak@meduniwien.ac.at
Backup dei contatti dello studio
- Nome: Edda M. Tschernko, MD, MBA
- Numero di telefono: 41060 +43-1-40400
- Email: edda.tschernko@meduniwien.ac.at
Luoghi di studio
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State of Vienna
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Vienna, State of Vienna, Austria, 1090
- General hospital Vienna
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Contatto:
- Martin Dworschak, MD, MBA
- Numero di telefono: 41090 +43-1-40400
- Email: martin.dworschak@meduniwien.ac.at
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Contatto:
- Edda M. Tschernko, MD, MBA
- Numero di telefono: 41060 +43-1-40400
- Email: edda.tschernko@meduniwien.ac.at
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Investigatore principale:
- Martin Dworschak, MD, MBA
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Sub-investigatore:
- Edda M. Tschernko, MD, MBA
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Sub-investigatore:
- Keso Skhirtladze-Dworschak, MD
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Sub-investigatore:
- Florentina Zingher, MD
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Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
- Adulto più anziano
Accetta volontari sani
Descrizione
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
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Terapia di supporto
- Assegnazione: N / A
- Modello interventistico: Assegnazione di gruppo singolo
- Mascheramento: Nessuno (etichetta aperta)
Numero di armi
Armi e interventi
Gruppo di partecipanti / ArmGruppo di partecipanti / Arm |
Intervento / TrattamentoIntervento / Trattamento |
|---|---|
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Comparatore attivo: 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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Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Lung aeration score of both lungs.
Lasso di tempo: 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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Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Radiologic assessment of Kerley B lines as indicators of lung edema.
Lasso di tempo: 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.
Lasso di tempo: 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).
Lasso di tempo: 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.
Lasso di tempo: 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.
Lasso di tempo: 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.
Lasso di tempo: 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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Altre misure di risultato
Altre misure di risultato
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Length of ICU and hospital stay.
Lasso di tempo: 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.
Lasso di tempo: 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.
Lasso di tempo: 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.
Lasso di tempo: 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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Collaboratori e investigatori
Sponsor
Sponsor
Investigatori
Investigatori
- Investigatore principale: Martin Dworschak, MD, MBA, Medical University of Vienna
Studiare le date dei record
Studia le date principali
Inizio studio (Stimato)
Inizio studio
Completamento primario (Stimato)
Completamento primario
Completamento dello studio (Stimato)
Completamento dello studio
Date di iscrizione allo studio
Primo inviato
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Primo Inserito
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento pubblicato
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Altri numeri di identificazione dello studio
Altri numeri di identificazione dello studio
- EK Nr: 1250/2021
Piano per i dati dei singoli partecipanti (IPD)
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