Assessment of Salbutamol Effect on Arterial Oxygenation in COPD Patients During One-lung Ventilation

N/AActive Not RecruitingNCT05914285

Yonsei University90 enrolled

Overview

One-lung ventilation (OLV) is essential part of anesthesia during thoracic procedures. However, OLV induces a drastic increase of intrapulmonary shunt due to maintained pulmonary perfusion through the nonventilated lung, which may result in severe hypoxemia. Although the protective mechanisms of hypoxic pulmonary vasoconstriction favorably modulate pulmonary perfusion to the ventilated lung, the effect is attenuated in patients with history of chronic obstructive pulmonary disease (COPD), which alters compliance of the pulmonary artery. Salbutamol is a selective short-acting beta2-agonist and when inhaled during OLV, it acts selectively on the pulmonary vasculature reducing pulmonary vascular resistance of well-ventilated lung. We hypothesized that inhaled salbutamol would alleviate ventilation-perfusion mismatch during OLV of COPD patients, and aimed to assess the effects of salbutamol on oxygenation in these patients.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

One-lung Ventilation Chronic Obstructive Pulmonary Disease

Interventions

5ml of inhaled normal salineDRUG

After the initiation of OLV, 5ml of normal saline is inhaled for 20 minutes using ultrasonic nebulizer, which is connected to the inspiratory limb of the ventilator system. Arterial blood gas analysis is performed 30 minutes after the completion of drug inhalation.

2.5mg (2.5ml) of inhaled salbutamol and 2.5ml of inhaled normal salineDRUG

After the initiation of OLV, mixture of salbutamol 2.5mg and normal saline 2.5ml is inhaled for 20 minutes using ultrasonic nebulizer, which is connected to the inspiratory limb of the ventilator system. Arterial blood gas analysis is performed 30 minutes after the completion of drug inhalation.

Eligibility

Sex: ALLMin age: 40 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patient age 40\~80yrs, scheduled for videoscope-assisted pulmonary lobectomy * American Society of Anesthesiologists Class III 또는 IV * Moderate or more severe COPD according to GOLD criteria (FEV1/FVC\<70%, FEV1\<80%) Exclusion Criteria: * New York Heart Association class \>II * AST level ≥100 IU/mL or ALT ≥ level 50 IU/L * Creatinine clearance \< 30mL/min * History of severe coronary artery occlusive disease, unstable angina, or recent myocardial infarction within 6 months * History of pulmonary hypertension or pulmonary edema * History of cerebrovascular accident within 3 months

Outcomes

Primary Outcomes

PaO2 (partial pressure of arterial oxygen) to FiO2 (fraction of inspired oxygen) ratio (P/F ratio)

The P/F ratio is a widely-used objective tool to identify hypoxemic respiratory failure when supplemental oxygen has been administered. It can be used to evaluate the effect of salbutamol on oxygenation during OLV.

Time frame: Thirty minutes after the completion of drug inhalation