Effect of Individualized Positive End-expiratory Pressure (PEEP) in Patients Who Have an Intrinsic PEEP During One-lung Ventilation
4. juni 2026 oppdatert av: Hyun Joo Ahn, Samsung Medical Center
Effects of Individualized Positive End-expiratory Pressure (PEEP) on Intrinsic PEEP and Stroke Volume During One-lung Ventilation: a Single-center, Randomized Crossover Study
This study investigates the effects of three extrinsic PEEP settings-5 cmH2O, 0 cmH2O, and an individualized PEEP (70% of the measured intrinsic PEEP)-on intrinsic PEEP and hemodynamic stability in patients with intrinsic PEEP undergoing lung resection surgery, using a randomized, crossover design.
Studieoversikt
Status
Har ikke rekruttert ennå
Intervensjon / Behandling
Detaljert beskrivelse
Intrinsic positive end-expiratory pressure (iPEEP) frequently occurs during one-lung ventilation (OLV), which is essential for lung resection.
This occurrence is driven by three primary factors.
First, a significant portion of patients undergoing lung surgery have concomitant chronic obstructive pulmonary disease (COPD) and thus possess a baseline intrinsic PEEP.
Second, high-frequency ventilation applied to prevent carbon dioxide accumulation during OLV shortens the expiratory time, thereby generating intrinsic PEEP.
Third, the use of a narrow-bore double-lumen endobronchial tube for OLV increases airway resistance, accelerating the development of intrinsic PEEP.
Intrinsic PEEP causes lung hyperinflation and elevates intrathoracic pressure, which can subsequently decrease venous return and lead to abrupt hypotension.
However, research remains insufficient regarding the optimal level of extrinsic PEEP for patients who develop intrinsic PEEP during OLV.
While an extrinsic PEEP of around 5 cmH2O is generally applied during OLV, some guidelines recommend completely removing extrinsic PEEP (0 cmH2O) during OLV in COPD patients.
Nevertheless, this recommendation lacks robust scientific evidence.
Furthermore, whether the strategy of setting extrinsic PEEP at approximately 70% of intrinsic PEEP-as suggested by studies in critically ill patients-is equally valid in the intraoperative OLV environment remains unverified.
Theoretically, if extrinsic PEEP exceeds intrinsic PEEP, it may exacerbate lung hyperinflation by increasing expiratory resistance.
Conversely, an extrinsic PEEP that is too low may cause airway collapse during expiration, paradoxically worsening gas trapping.
Therefore, this study aims to evaluate the effects of three extrinsic PEEP settings-5 cmH2O, 0 cmH2O, and an individualized PEEP (70% of the measured intrinsic PEEP)-on intrinsic PEEP and hemodynamic stability using a randomized, crossover design.
Studietype
Intervensjonell
Registrering (Antatt)
48
Fase
- Ikke aktuelt
Kontakter og plasseringer
Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.
Studiekontakt
- Navn: Hyun Joo Ahn, MD, PhD
- Telefonnummer: +82234100784
- E-post: hyunjooahn@skku.edu
Studer Kontakt Backup
- Navn: Heejoon Jeong, MD
- Telefonnummer: +82234100841
- E-post: heejoonjeong@skku.edu
Deltakelseskriterier
Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
- Voksen
- Eldre voksen
Tar imot friske frivillige
Nei
Beskrivelse
Inclusion Criteria:
- American Society of Anesthesiologists Physical Status I - III
- The Eastern Cooperative Oncology Group Performance Status Grade 0 - 2
- Lung resection surgery requiring one-lung ventilation for over 60 minutes
- Indication of double-lumen endobronchial tube (female 35 Fr, male 37 Fr)
- Patient who is diagnosed with intrinsic PEEP during one-lung ventilation
Exclusion Criteria:
- Large bullae
- Emergency surgery
- Mechanical ventilation before surgery
- Hemodynamic instability before surgery
- Surgery requiring cardiopulmonary bypass
- Pregnancy, breastfeeding patient
- Patient's refusal to participate
- No intrinsic PEEP during one-lung ventilation
Studieplan
Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: N/A
- Intervensjonsmodell: Enkeltgruppeoppdrag
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
|---|---|
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Eksperimentell: Experimental group
During one-lung ventilation, baseline intrinsic PEEP and stroke volume will be measured.
All participants will receive three PEEP interventions: 0 cmH2O, 5 cmH2O, and 70% of the intrinsic PEEP value.
The order of interventions is randomized.
Each intervention will be maintained for 5 minutes, with a 5-minute washout period between interventions to minimize mutual interference.
At the end of each intervention, two primary outcomes (intrinsic PEEP and stroke volume) will be measured.
|
PEEP 0 (zero) means off-PEEP on the anesthesia machine.
PEEP5 means setting the PEEP to 5 cmH2O on the anesthesia machine.
PEEPi (individualized PEEP) means setting the PEEP to 70% of intrinsic PEEP on the anesthesia machine.
|
Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
Intrinsic positive end-expiratory airway pressure
Tidsramme: During a 30-minute period from the start of one-lung ventilation to the completion of the intervention
|
During one-lung ventilation, each patient will randomly receive three PEEP interventions: 0 cmH2O, 5 cmH2O, and the 70% value of intrinsic PEEP.
After each 5-minute intervention, intrinsic PEEP will be measured by the anesthesia machine.
|
During a 30-minute period from the start of one-lung ventilation to the completion of the intervention
|
|
Stroke volume
Tidsramme: During a 30-minute period from the start of one-lung ventilation to the completion of the intervention
|
During one-lung ventilation, each patient will randomly receive three PEEP interventions: 0 cmH2O, 5 cmH2O, and the 70% value of intrinsic PEEP.
After each 5-minute intervention, Stroke volume will be measured by an arterial pressure-based cardiac output monitor.
|
During a 30-minute period from the start of one-lung ventilation to the completion of the intervention
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Samarbeidspartnere og etterforskere
Det er her du vil finne personer og organisasjoner som er involvert i denne studien.
Sponsor
Etterforskere
- Hovedetterforsker: Hyun Joo Ahn, MD, PhD, Samsung Medical Center
Studierekorddatoer
Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.
Studer hoveddatoer
Studiestart (Antatt)
1. juni 2026
Primær fullføring (Antatt)
31. mai 2027
Studiet fullført (Antatt)
31. mai 2027
Datoer for studieregistrering
Først innsendt
21. mai 2026
Først innsendt som oppfylte QC-kriteriene
4. juni 2026
Først lagt ut (Faktiske)
10. juni 2026
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
10. juni 2026
Siste oppdatering sendt inn som oppfylte QC-kriteriene
4. juni 2026
Sist bekreftet
1. juni 2026
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- Individual PEEP trial
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