Individualized Lung Recruitment Maneuver Guide by Pulse-oximetry in Anesthetized Patients

Fundación para la Investigación del Hospital Clínico de Valencia30 enrolled

Overview

General anesthesia and mechanical ventilation promotes atelectasis and airway closure. The open-lung approach (OLA) strategy restores the functional residual capacity. Pulse oximetry hemoglobin saturation (SpO2) using room air can diagnose shunt induced by lung collapse during general anesthesia and the SpO2 breathing air was useful to detect the lung´s opening and closing pressure during a recruitment maneuver (RM) in morbidly obese anesthetized patients. Investigators hypothesized that the SpO2 breathing air can personalize the open-lung approach.

Increase in airway pressure until the SpO2 reaches 97% (lung´s opening pressure) during the incremental positive end-expiratory (PEEP) limb. Decrease in the PEEP level until the SpO2 decreases bellow 97% (lung´s closing pressure)

Study Type

OBSERVATIONAL

Enrollment

Conditions

Abdominal Cancer

Interventions

Open-lung approachOTHER

Increase and decrease in airway pressure to open the lung and keep them opened.

Medical Language ↔ Plain English

Inclusion Criteria: * Non-obese patients with ASA physical status I-III undergoing elective abdominal laparoscopic surgery with an expected operating time of less than 2 hours were included. Exclusion Criteria: * age of \<18 years, * preoperative SpO2 ≤97% while breathing room air, and * patients with previous known cardiac or respiratory disease.

Outcomes

Primary Outcomes

open-lung condition

The role of the SpO2 to detect lung´s closing and opening pressures was evaluated by the discrete receiver operating characteristic (ROC) analysis. With PtpEE and PaO2/FIO2 as the reference methods, a binary classification of "1" to the open-lung condition defined as positive PtpEE or PaO2/FIO2 \>400 mmHg and "0" presence of lung collapse defined as negative PtpEE or PaO2/FIO2 \<400 mmHg. Also, a value of "1" was assigned when the SpO2 was ≥ 97% and a value of "0" when the value was \< 97%.

Time frame: During the experimental protocol (Intraoperative)