Ventilated Patients especially those undergoing upper abdominal surgeries are prone to lung atelectasis. They are at risk of adverse effects secondary to inadequate lung ventilation. Applied PEEP and Recruitment maneuver are thought to enhance lung aeration under general anesthesia which could be assessed by ultrasound.
The aim of our study is to assess the effect of using PEEP with and without recruitment maneuver on atelectasis and lung aeration during open upper abdominal surgeries by ultrasonography. Application of PEEP improves intraoperative oxygenation and thus could minimize the incidence of postoperative atelectasis and respiratory complications during abdominal surgeries. A recent study found that PEEP and RM prevented intraoperative aeration loss, which didn't persist after extubation when comparing effects of positive end-expiratory pressure/recruitment maneuvers with zero end-expiratory pressure on atelectasis during open gynecological surgery by ultrasonography
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
117
Patients will be ventilated with a PEEP of 4 cm H2O and no RMs throughout the study
PEEP of 10 cm H2O will be applied
PEEP of 10 cm H2O and RM (30 cm H2O for 30 s) immediately after the second lung ultrasonographic examination and repeated every 30 minutes till emergence
Mansoura University
Al Mansurah, DK, Egypt
Pre-emergence LUS score
Lung ultrasonography score (LUS score) between groups at the end of surgery (just before emergence) as a lower LUS indicates better lung aeration.
Time frame: intraoperative before recovery from anesthesia
Lung ultrasonography score (LUS score)
Lung ultrasonography score (LUS score) between groups
Time frame: preoperative, intraoperative for anesthesia duration to 1 hour postoperative
Heart rate
heart rate between groups at each time point of LUS score performance
Time frame: preoperative, intraoperative for anesthesia duration to 1 hour postoperative
Mean blood pressure
mean arterial blood pressure between groups at each time point of LUS score performance
Time frame: preoperative, intraoperative to 1 hour postoperative
oxygen saturation
patient oxygen saturation between groups at each time point of LUS score performance
Time frame: preoperative, intraoperative to 1 hour postoperative
End-tidal carbon dioxide tension
end tidal CO2 between groups post induction, post recruitment and before extubation
Time frame: intraoperative for anesthesia duration
Arterial partial pressure of oxygen (PaO2)
arterial blood gases post induction, before extubation and at the PACU
Time frame: Intraoperative and 15 min postoperative
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The thorax will divided into 12 quadrants, each of them will be assigned a score of 0-3 as 0, normal lung sliding with fewer than three single B lines 1. three or more B lines 2. coalescent B lines 3. consolidated lung. The LUS (0-36) will be calculated with higher scores indicating more aeration loss
Arterial partial pressure of carbon dioxide (PaCO2)
arterial blood gases post induction, before extubation and at the PACU
Time frame: Intraoperative and 15 min postoperative
PaO2/FiO2
arterial blood gases post induction, before extubation and at the PACU
Time frame: Intraoperative and 15 min postoperative
Peak inspiratory pressure
peak inspiratory pressure between groups after intubation
Time frame: intraoperative for anesthesia duration
Postoperative pulmonary complications (PPCs)
PPCs include (pneumothorax, pleural effusion, pulmonary collapse, atelectasis, pneumonia, acute respiratory distress syndrome (ARDS), or pulmonary aspiration).
Time frame: 5 days