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Perioperative Change of Regional Ventilation During Spontaneous Breathing

29 februari 2016 uppdaterad av: Wuerzburg University Hospital
Perioperative changes in regional ventilation by pulmonary electrical impedance tomography and spirometry will be investigated in patients at risk for postoperative pulmonary complications. Those patients undergo abdominal and limb operations. In a pilot study arm electrical impedance tomography is tested in patients receiving osteosynthesis of serial rib fractures.

Studieöversikt

Status

Avslutad

Betingelser

Intervention / Behandling

Detaljerad beskrivning

Postoperative pulmonary complications (Defined as pulmonary infection, pleural effusion, atelectasis, pneumothorax, bronchospasm, aspiration pneumonitis or respiratory insufficiency subsequent to surgery) increase the morbidity and mortality of surgical patients. Several independent factors determined by the patients' characteristics and the operative procedure increase the risk for those complications. The postoperative decrease of values measured by spirometry, such as the forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), were found in patients after major surgical procedures for several days. The postoperative reduction of those measurement can be the result of general functional limitations in those patients (e.g. by postoperative pain) or the result of a regional postoperative pulmonary complication (e.g. atelectasis, pleural effusion). The method of the electrical impedance tomography (EIT) enables to visualize the regional ventilation within a transversal section of the lung in real time. Studies examining the change of pulmonary EIT for several days postoperatively in spontaneously breathing patients are lacking. The aim of the present study is to examine perioperative changes in regional ventilation in spontaneously breathing patients during their recovery after abdominal and limb surgery. Moreover, the association of those changes with expected changes in spirometry is tested. Finally, in patients with evident postoperative pulmonary complications the value of pulmonary EIT to detect those changes is investigated. The study should improve the knowledge about the development of postoperative pulmonary complications and test the scientific and clinical value of pulmonary EIT in those spontaneously breathing patients.

In a group of patients undergoing osteosynthesis of a flail chest, it is tested how regional ventilation changes by these operations and whether pulmonary EIT is actually usable in these patients.

Studietyp

Observationell

Inskrivning (Faktisk)

72

Kontakter och platser

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Studieorter

      • Würzburg, Tyskland, 97080
        • University of Würzburg

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

18 år och äldre (Vuxen, Äldre vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Testmetod

Icke-sannolikhetsprov

Studera befolkning

adult inpatients undergoing elective surgery

Beskrivning

Inclusion Criteria:

  • Adult
  • Inpatient
  • Surgery under general anesthesia with and without additional regional anesthesia
  • increased risk for postoperative pulmonary complications according to the ARISCAT-Score (except pilot arm for osteosynthesis of flail chest)

Exclusion Criteria:

  • Missing informed consent
  • Outpatient
  • Emergency procedure
  • Revision surgery of hospitalized patients
  • Operation under local or regional anesthesia alone
  • Expected postoperative ventilation
  • Expected hospital stay of less than three days
  • Pregnancy
  • Allergy against material of the electrode belt (silicone rubber, stainless steel, gold-plated brass)
  • Injured, inflamed or otherwise affected skin within the target region of the electrode belt
  • Unstable spine injury
  • Body mass index of more than 50 kg/m2
  • Incapacity to lie quietly for the examination
  • Pacemaker, defibrillator or other active implant
  • Reoperation before the examination at the third postoperative day

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

Kohorter och interventioner

Grupp / Kohort
Intervention / Behandling
abdominal surgery
27 patients undergoing abdominal surgery having an elevated risk for postoperative pulmonary complications will be examined by perioperative pulmonary function tests
Pulmonary electrical impedance tomography, spirometry, pulse oximetry and query performed preoperatively, at the first and the third postoperative day
limb surgery
27 patients undergoing upper and lower limb surgery having an elevated risk for postoperative pulmonary complications will be examined by perioperative pulmonary function tests
Pulmonary electrical impedance tomography, spirometry, pulse oximetry and query performed preoperatively, at the first and the third postoperative day
flail chest
10 patients undergoing an operative stabilization of a flail chest will be examined by perioperative pulmonary function tests
Pulmonary electrical impedance tomography, spirometry, pulse oximetry and query performed preoperatively, at the first and the third postoperative day

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Change from baseline in regional ventilation at the first postoperative day
Tidsram: baseline and 1. postoperative day
Regional ventilation is measured by pulmonary electrical impedance tomography. The change in the calculated 'Center of Ventilation' in the sagittal direction is used for the primary outcome measure. Power calculation accounts for the use of two time points for the primary outcome measure.
baseline and 1. postoperative day
Change from baseline in regional ventilation at the third postoperative day
Tidsram: baseline and 3. postoperative day
Regional ventilation is measured by pulmonary electrical impedance tomography. The change in the calculated 'Center of Ventilation' in the sagittal direction is used for the primary outcome measure. Power calculation accounts for the use of two time points for the primary outcome measure.
baseline and 3. postoperative day

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Change in forced vital capacity (FVC)
Tidsram: baseline, 1. and 3. postoperative day
Measured by spirometry. The best value of three attempts is used.
baseline, 1. and 3. postoperative day

Andra resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Change in forced expiratory volume in one second (FEV1)
Tidsram: baseline, 1. and 3. postoperative day
Measured by spirometry. The best value of three attempts is used.
baseline, 1. and 3. postoperative day
Change in peripheral oxygen saturation
Tidsram: baseline, 1. and 3. postoperative day
Measured by pulse oximetry
baseline, 1. and 3. postoperative day
Change in pain score
Tidsram: baseline, 1. and 3. postoperative day
Measured by visual analogue scale
baseline, 1. and 3. postoperative day
Change in respiratory rate
Tidsram: baseline, 1. and 3. postoperative day
Measured by electric impedance tomography
baseline, 1. and 3. postoperative day
pulmonary complications
Tidsram: baseline, 1., 3. and 7. postoperative day or at discharge
Defined as pulmonary infection, pleural effusion, atelectasis, pneumothorax, bronchospasm, aspiration pneumonitis or respiratory insufficiency
baseline, 1., 3. and 7. postoperative day or at discharge

Samarbetspartners och utredare

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Sponsor

Utredare

  • Huvudutredare: Markus Kredel, PD. Dr. med, University of Würzburg, Department of Anaesthesia and Critical Care

Publikationer och användbara länkar

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Allmänna publikationer

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart

1 januari 2015

Primärt slutförande (Faktisk)

1 februari 2016

Avslutad studie (Faktisk)

1 februari 2016

Studieregistreringsdatum

Först inskickad

1 december 2014

Först inskickad som uppfyllde QC-kriterierna

13 april 2015

Första postat (Uppskatta)

17 april 2015

Uppdateringar av studier

Senaste uppdatering publicerad (Uppskatta)

1 mars 2016

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

29 februari 2016

Senast verifierad

1 februari 2016

Mer information

Termer relaterade till denna studie

Andra studie-ID-nummer

  • perioperativeEIT

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