Protective ventilation strategy has been widely applied in the field of thoracic surgery requiring one-lung ventilation to reduce postoperative pulmonary complications. Low tidal volume, positive end-expiratory pressure (PEEP), and intermittent recruitment maneuver are key components of protective ventilation strategy. Recent evidence suggests that a tidal volume of 4-5 ml/kg should be applied during protective one-lung ventilation. However, optimal level of PEEP is still unclear. This study aims to investigate optimal level of PEEP to minimize postoperative atelectasis by comparing modified lung ultrasound score in patients applied protective one-lung ventilation using PEEP of 3, 6, or 9 cm of water during thoracic surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
142
PEEP of 3 cm of water will be applied during one-lung ventilation.
PEEP of 6 cm of water will be applied during one-lung ventilation.
PEEP of 9 cm of water will be applied during one-lung ventilation.
Seoul National University Hospital
Seoul, South Korea
Modified lung ultrasound score
The score is calculated by adding up the 12 individual quadrant scores assessed using lung ultrasound.
Time frame: Postoperative 1 hour
Intraoperative desaturation
Oxygen saturation by pulse oximetry \<95% during one-lung ventilation
Time frame: Average time of 60-90 minutes
Intraoperative partial pressure of arterial oxygen/fraction of inspired oxygen ratio
partial pressure of arterial oxygen/fraction of inspired oxygen ratio during one-lung ventilation
Time frame: Average time of 60-90 minutes
Postoperative desaturation
Oxygen saturation by pulse oximetry \<95%
Time frame: Postoperative 24 hours
plasma Tumor Necrosis Factor-α
proinflammatory cytokine
Time frame: 10 minutes after initiation of one-lung ventilation
plasma Interleukin-6
proinflammatory cytokine
Time frame: 10 minutes after initiation of one-lung ventilation
plasma Interleukin-10
anti-inflammatory cytokine
Time frame: 10 minutes after initiation of one-lung ventilation
Postoperative pulmonary complication
Composite outcome of atelectasis, pneumonia, acute respiratory distress syndrome, or pulmonary aspiration
Time frame: Postoperative 7 days
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