Effect of Recruitment Maneuvers Plus Optimal PEEP Versus Optimal PEEP Alone in One Lung Ventilation

Università degli Studi di Ferrara60 enrolled

Overview

The intraoperative driving pressure (∆P) has been recently identified as the greater independent predictor of postoperative pulmonary complications after one lung ventilation (OLV). The application of a positive end-expiratory pressure (PEEP) level of 5 or 10 cmH2O has been shown to reduce the ∆P and the V/Q mismatch (Spadaro 2017); however, the "optimal" PEEP level able to minimize the ∆P may change significantly across patients. The aim of this study is to describe the optimal PEEP levels in patients undergoing thoracic surgery

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Mechanical Ventilation Complication

Interventions

Recruitment manoeuvers

Recruitment manoeuvers will be performed as follow Recruitment manoeuvers 1. set FIO2 at 1.0 2. Ppeak limit at 45 cmH2O 3. Respiratory rate set at 6 4. I:E set at 1:1 5. Raise the VT at step of 2 ml/kg PBW until the Pplat is between 30-40 cmH2O 6. If the maximum VT is set without rasing the Pplat, raise PEEP 7. Allow three respiratory cycles with Pplat between 30 and 40 cmH2O 8. End of RM The recruitment manouvers will be performed after 20 minutes of OLV. At the end of the RM, the VT will be set back to 5 ml/kg while the PEEP will be chosen according to the best static compliance with a decremental trial (from 16 cmH2O, lowering PEEP with steps of 2 cmH2O each until the best compliance is reached).

incremental PEEPPROCEDURE

In this group the a PEEP level will be added after 20 minutes from OLV. PEEP values will be chosen according to the best static compliance with an incremental trial (i.e. starting from ZEEP, the PEEP values will be increased in step of 2 cmH2O each until the best compliance is reached

Eligibility

Sex: ALLMin age: 18 YearsMax age: 90 Years

Medical Language ↔ Plain English

Inclusion Criteria: • Patients undergoing VATS with OLV ≥2 hours Exclusion Criteria: * ASA (American Society of Anesthesiologists Physical Status Classiﬁcation) score ≥ 4 * severe chronic respiratory failure (chronic obstructive pulmonary disease patients with GOLD stage 3 or 4 * preoperative hemoglobin less than 10 g ml-1 * hemodynamic instability (defined as a decrease in systolic arterial pressure of more than 20% from baseline),

Outcomes

Primary Outcomes

pulmonary shunt, expressed as percentage, measured by ALPE system

Time frame: 20 minutes after intervention

Secondary Outcomes

intraoperative driving pressure, measured as plateau pressure - PEEP