Peroperative Use of Positive End-expiratory Pressure Prevents Formation of Atelectasis as Studied by Computerised Tomography at End of Surgery

NCT ID: NCT02548416

Last Updated: 2017-11-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

24 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-11-30

Study Completion Date

2016-11-30

Brief Summary

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Atelectasis is common during and after general anaesthesia and a number of interventions have been suggested in order to prevent their formation. The use of Positive End Expiratory Pressure (PEEP) during general anaesthesia has in recent years been questioned.

The investigators hypothesize that the use of PEEP as a single intervention improves oxygenation and prevents atelectasis as investigated by computed tomography compared to a control group with zero PEEP.

Detailed Description

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Conditions

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Atelectasis

Keywords

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Atelectasis Positive End-Expiratory Pressure Oxygenation Anaesthesia Computed tomography

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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PEEP group

Induction and maintenance of anaesthesia in a conventional manner. Peroperative ventilatory settings using positive end-expiratory pressure.

Group Type ACTIVE_COMPARATOR

Positive end-expiratory pressure

Intervention Type PROCEDURE

Induction of anaesthesia is performed in a conventional manner using a target controlled infusion of propofol and remifentanil. Intubation of the trachea is facilitated by rocuronium.

As soon as correct position of the endotracheal tube is confirmed, controlled ventilation is started with a tidal volume of 7 mL/kg body weight and a respiratory frequency of 10. The fresh gas flow is set to 1 litre/min with an oxygen mixture of 40%, aiming for an inspired oxygen fraction (FiO2) of 30-35%. Positive end-expiratory pressure is set to 6 or 8 cm H20 (8 if BMI\>25) in the intervention group.

Unless the patient´s SpO2 falls below 90%, the FiO2 remains unchanged throughout the procedure.

Control group zero PEEP

Induction and maintenance of anaesthesia in a conventional manner. Peroperative ventilatory settings using zero end-expiratory pressure.

Group Type ACTIVE_COMPARATOR

Control group, zero PEEP

Intervention Type PROCEDURE

Induction of anaesthesia is performed in a conventional manner using a target controlled infusion of propofol and remifentanil. Intubation of the trachea is facilitated by rocuronium. As soon as correct position of the endotracheal tube is confirmed, controlled ventilation is started with a tidal volume of 7 mL/kg body weight and a respiratory frequency of 10. The fresh gas flow is set to 1 litre/min with an oxygen mixture of 40%, aiming for an inspired oxygen fraction (FiO2) of 30-35%. Zero PEEP is used.

Unless the patient´s SpO2 falls below 90%, the FiO2 remains unchanged throughout the procedure.

Interventions

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Positive end-expiratory pressure

Induction of anaesthesia is performed in a conventional manner using a target controlled infusion of propofol and remifentanil. Intubation of the trachea is facilitated by rocuronium.

As soon as correct position of the endotracheal tube is confirmed, controlled ventilation is started with a tidal volume of 7 mL/kg body weight and a respiratory frequency of 10. The fresh gas flow is set to 1 litre/min with an oxygen mixture of 40%, aiming for an inspired oxygen fraction (FiO2) of 30-35%. Positive end-expiratory pressure is set to 6 or 8 cm H20 (8 if BMI\>25) in the intervention group.

Unless the patient´s SpO2 falls below 90%, the FiO2 remains unchanged throughout the procedure.

Intervention Type PROCEDURE

Control group, zero PEEP

Induction of anaesthesia is performed in a conventional manner using a target controlled infusion of propofol and remifentanil. Intubation of the trachea is facilitated by rocuronium. As soon as correct position of the endotracheal tube is confirmed, controlled ventilation is started with a tidal volume of 7 mL/kg body weight and a respiratory frequency of 10. The fresh gas flow is set to 1 litre/min with an oxygen mixture of 40%, aiming for an inspired oxygen fraction (FiO2) of 30-35%. Zero PEEP is used.

Unless the patient´s SpO2 falls below 90%, the FiO2 remains unchanged throughout the procedure.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Healthy subjects, American Society of Anesthesiology (ASA) I-II.
* Patients scheduled for non-abdominal day case surgery under general anaesthesia.

Exclusion Criteria

* ASA class III or higher.
* Body Mass Index (BMI) 30 or higher.
* Arterial oxygen saturation (SpO2) \<96% breathing air.
* Chronic Obstructive Pulmonary Disease (COPD).
* Ischaemic heart disease.
* Known or anticipated difficult airway.
* Active smokers and ex-smokers with a history of more than 6 pack years.
* Need for interscalene or supraclavicular plexus block for postoperative pain relief (risk of phrenic nerve paralysis).
Minimum Eligible Age

40 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Region Västmanland

OTHER

Sponsor Role lead

Responsible Party

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Erland Ostberg

M.D.

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Lennart Edmark

Role: STUDY_DIRECTOR

Region Västmanland

Locations

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Region Västmanland

Köping, , Sweden

Site Status

Countries

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Sweden

Other Identifiers

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Dnr 2015/338

Identifier Type: -

Identifier Source: org_study_id