Optimizing PEEP in Laparoscopic Bariatric Surgery Using Bedside Lung Ultrasound

Cairo University40 enrolled

Overview

Lung ultrasound imaging is a promising non-invasive, non-radiant, portable and easy to use tool that as yet to be studied in the intraoperative setting. in our current study, we are trying to reach the optimum PEEP in laparoscopic bariatric patients to prevent postoperative collapse and atlectasis with simple non-invasive procedure.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

DOUBLE

Enrollment

Conditions

Atelectasis, Postoperative Pulmonary

Interventions

stepwise PEEPDEVICE

* a PEEP of 4 cmH2O will be used after intubation till 5 minutes after pneumoperitonium, and adjusted in a step wise approach after lung ultrasound by adding 2 cmH2O, repeating ultrasound 5 minutes after every change in peep till no lung collapse is detected by lung ultrasound with a maximal peep of 10 cmH2O, or if hemodynamic instability occurs. * Lung ultrasound examination will be performed at a minimum three times in each patient; the first will be performed 1 min after starting mechanical ventilation of the lungs, 5 minutes after pneumoperitonium, 5 min after every peep increase in stepwise peep group and the last time at the end of the surgery. We define anaesthesia-induced atelectasis to be significant if any region has a consolidation score of ≥ 2.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * they are between 18 and 65 years of age * BMI more than 35 * patients with normal respiratory functions * ASA 1 or 2 Exclusion Criteria: * Previous lung surgery * Bronchial asthma * Contralateral lung bullae 4. Uncompensated cardiac disease (NYHA class 3 or 4) 5. Obstructive or restrictive lung disease 6. Patients on home oxygen therapy 7. Hemodynamic instability and increased intracranial pressure 8. In adittion , any patient who developes hemodynamic instability (MAP \<60mmHg) or hypoxia (Po2 less than 60) during the study will excluded from the study

Locations (1)

Faculty of Medicine

Cairo, Egypt

Outcomes

Primary Outcomes

efficacy of lung ultrasound in optimizing peep

to evaluate the effect of lung ultrasound in optimizing peep in obese patients undergoing laparoscopic surgeries on the Incidence of intraoperative hypoxia and atlectasis

Time frame: intraoperative and early postoperative first 24 hours after recovery from anaesthesia

Secondary Outcomes

effect on early postoperative oxygenation

Evaluating the effect of stepwise PEEP approach on the incidence of early postoperative in the first 24 hours atelectasis and oxygenation.

Time frame: 24 hours postoperative

Data from ClinicalTrials.gov

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