Protective Mechanical Ventilation and Risk of Postoperative Complications in Abdominal Surgery

NCT ID: NCT03165760

Last Updated: 2017-05-24

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 80 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2015-07-01
• Study Completion Date: 2016-12-31

Brief Summary

Randomized controlled trial, comparing two groups of 40 patients each scheduled for open major abdominal surgery. The intervention group was ventilated with a protective strategy consisting on a low Tidal volume (Vt) (6ml/kg of predicted body weight (PBW)), positive end expiratory pressure (PEEP) = 10 cm H2O and recruitment manoeuvres (RM) after disconnection from the ventilator, the control group had classic ventilation (Vt = 8 ml/kg of PBW, PEEP = 4 cmH2O and no RM).

Detailed Description

This randomized controlled trial, was approved by the institutional ethics committee of our hospital. Informed consent was obtained from all the participants before randomization. Investigators included 80 patients (40 in each group), ASA I or II, planned for open abdominal surgery lasting more than 2 hours under general anesthesia.

Patients were not included if they had specially acute respiratory disease, severe asthma or emphysema, sleep apnea syndrome, septic shock and body mass index (BMI) < 16 or > 35 Kg/m2. Participants were excluded in case of serious peroperative anesthetic complications or hemorrhagic shock.

Primary endpoint was postoperative pulmonary complications occurring within the first 7 days after surgery (defined as hypoxemia, Broncho-pneumopathy, pulmonary infiltrate, acute respiratory distress syndrome, atelectasis, pleural effusion).

Secondary endpoints for all participants were intra-operative complications (change in SpO2 when dropped less than 90%, hypotension <90 mmHg lasting more than 3 min, need for vasopressor administration, new arrhythmia), postoperative extrapulmonary complications (septic shock, postoperative surgical complications, heart disease complications). Investigators recorded for all participants length of hospital stay and mortality rate were .

Investigators randomly allocated patients before entering to the operating room to:

• Control Group (CG): patients ventilated with Vt of 8 ml/kg of predicted body weight (PBW), a low level of PEEP (4 cm H2O) without RM.
• Protective Ventilation Group (PVG): patients ventilated with a low Vt of 6 ml/Kg of PBW, a high level of PEEP (10 cm H2O), RMs applied after intubation, before extubation and in case of disconnection from the ventilator.

Other ventilation settings, type of anesthesia, fluid administration and post operative pain management were standardized.

In the postoperative period, investigators daily assessed clinical examination and arterial blood gas if pulse oximetry dropped. For all participants, a chest X ray, blood count creatinine and C reactive protein were done at day 1 and day 3.

Data were presented as means and standard deviation [SD] or frequencies. Statistical analyses were performed using SPSS statistical software version 20.0. A p-value of 0.05 was considered significant.

Conditions

Ventilator-Induced Lung Injury; Mechanical Ventilation Complication; Postoperative Complications

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: NONE

Study Groups

control group

Vt = 8 ml/kg of PBW and PEEP = 4 cm H2O

Group Type: NO_INTERVENTION

No interventions assigned to this group

protective ventilation group

Vt = 6ml/kg of PBW, PEEP = 10 and RM if disconnected

Group Type: EXPERIMENTAL

protective ventilation

Intervention Type: PROCEDURE

the aim of the intervention is to ovoid Ventilator induced lung injury and inflammatory stress

Interventions

protective ventilation

the aim of the intervention is to ovoid Ventilator induced lung injury and inflammatory stress

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• ASA I or II, planned for open abdominal surgery lasting more than 2 hours under general anesthesia

Exclusion Criteria

• Patients were not included if they had specially acute respiratory disease, severe asthma or emphysema, sleep apnea syndrome, septic shock and BMI < 16 or > 35 Kg/m2. They were excluded in case of serious peroperative anesthetic complications or hemorrhagic shock.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Mongi Slim Hospital

OTHER

Sponsor Role: lead

Responsible Party

Mhamed Sami Mebazaa

professor head of the anesthesiology-ICU departement

Responsibility Role: PRINCIPAL_INVESTIGATOR

Other Identifiers

Mongi Slim OR

Identifier Type: -

Identifier Source: org_study_id