Vascular Injury in Mechanical Ventilation: a Proof-of-Concept Study

University of Manitoba19 enrolled

Overview

Investigation of the effect of mechanical ventilation on biomarkers of microvascular damage

The objective of this study is to determine the effect of mechanical ventilation (MV) on endothelial biomarkers associated with ventilator-induced vascular injury (VIVI), and determine the correlation of these biomarkers with non-invasive microvascular perfusion monitoring data and semaphorin 3E levels. Blood samples will be collected immediately pre-operatively and post-operatively. Biomarkers will be expressed as an absolute value and as a relative percentage change from baseline to account for inter-individual variability. Hemodynamic and surgical variables will be extracted from the OR data: blood pressure, oxygen saturation, blood loss, fluid administration, length of surgery, and MV parameters such as tidal volume, inspired oxygen, respiratory rate, and positive end-expiratory pressure. During surgery, patients will be monitored using a non-invasive near-infrared spectroscopy technique to quantify skeletal muscle microvascular perfusion. These devices will be applied immediately prior to induction of anesthetic and data collected until immediately prior to transfer to the post-anesthesia care unit.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Mechanical Ventilation Complication Vascular Injury Endothelial Dysfunction

Interventions

Mechanical VentilationPROCEDURE

Positive pressure mechanical ventilation

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Age 18 years or greater * Patients undergoing elective orthopedic, endourologic, or plastic surgery procedure which is amenable to both general anesthetic or regional/neuraxial anesthesia Exclusion Criteria: * Emergency surgery * Polytrauma * Tourniquet use * Controlled hypotension * Mechanical ventilation less than 60 minutes in duration * American Society of Anesthesiologists class 4 or greater * Status postpneumonectomy * Pulmonary hypertension * Oxygen therapy during last month * Severe obesity (body mass index ≥40 kg/m2) * Immunosuppression within 3 months * Diagnosed infection * Shock

Locations (1)

Health Sciences Center

Winnipeg, Manitoba, Canada

Outcomes

Primary Outcomes

Relative change of postoperative Granulocyte-macrophage colony-stimulating factor (GM-CSF) plasma concentration relative to preoperative plasma concentration

Percentage change in concentration from immediately prior to surgical procedure to immediately after surgical procedure