Continuous Positive Airway Pressure After Abdominal Surgery

NCT ID: NCT04747535

Last Updated: 2021-04-30

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-05-10

Study Completion Date

2023-12-31

Brief Summary

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This is a randomized controlled trial with an allocation ratio of 1:1. Half the patients are randomized to continuous positive airway pressure (CPAP) and half to routine medical care. Included are one hundred and twenty patients aged 18-80 years plus patients with ongoing CPAP scheduled for abdominal surgery at Umeå university hospital. The primary outcome is oxygen partial pressure (PaO2) measured on postoperative day 2 compared with the day before surgery. Secondary outcomes include diffusion capacity for carbon-monoxide, vital capacity, FEV1 and carbon-dioxide partial pressure (PaCO2) on postoperative day 2 compared with the day before surgery. PaO2 and PaCO2 are recorded from blood gas measurements obtained from the radial artery. Percentage of nocturnal hypoxia defined as the percentage of oxygen saturation during 90% of the second postoperative night. Tolerance to CPAP measured by the number of hours used CPAP. Side effects related to CPAP. All patients are examined with a simplified sleep apnea examination (Noxturnal T3, Res Med) the night before surgery.

Patients in the CPAP treated group are given an auto-CPAP with a minimum pressure of 5 cm and a maximum pressure of 10 cm. They will be treated with CPAP for at least 2 hours immediately after surgery and during the first two postoperative nights. Oxygen is supplied to CPAP if oxygen saturation falls below 90%. Patients in the control group receives standard treatment and supplemental oxygen if oxygen saturation falls below 90%. In a third arm, we will include patients who already are using CPAP at night at home for previously diagnosed obstructive sleep apnea. are instructed to use CPAP for 2 hours immediately after surgery and subsequent nights during hospital stay.

Detailed Description

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Theory Research question: Does nasal CPAP abolish postoperative hypoxia and lung function decline after abdominal surgery?

Methods This is a randomized controlled trial with an allocation ratio of 1:1. Half of the patients are randomized to CPAP and half to routine medical care. Randomization is generated by a computer program and handled by a person outside the study. Randomization procedure is documented by the contact person and in the patient's study protocol.

Include are one hundred and twenty patients age 18-80 years old, scheduled for abdominal surgery at Umeå university hospital. Excluded are patients with American Society of Anesthesia (ASA) class 2-3 and patients with cognitive impairment or dementia, unable to participate. Patients with ongoing CPAP treatment are not randomized. Instead, they form a separate group with ongoing CPAP after surgery

The primary outcome is oxygen partial pressure (PaO2) measured on postoperative day 2 compared with the day before surgery.

Secondary outcomes include diffusion capacity for carbon-monoxide, vital capacity, FEV1 and carbon-dioxide partial pressure (PaCO2) on postoperative day 2 compared with the day before surgery.

PaO2 and PaCO2 are recorded from blood gas measurements obtained from the radial artery. Percentage of nocturnal hypoxia defined as the percentage of oxygen saturation during 90% of the second postoperative night. Tolerance to CPAP measured by the number of hours used CPAP. Side effects related to CPAP.

All patients are examined with a simplified sleep apnea examination (Noxturnal T3, Res Med) the night before surgery.

A need of 35 patients in each arm was estimated to detect a difference in mean (SD) in PaO2 of 1 (1.5) kilo Pascal with a significance of p\<0.05 and a power of 80%. Due to dropouts, it is estimated a need to include and randomize 120 patients.

Patients in the CPAP treated group are given an auto-CPAP that can increase the pressure during respiratory arrest (AirSense 10 AutoSet, ResMed Inc) including a silicone nasal mask. It is set with a minimum pressure of 5 cm and a maximum pressure of 10 cm during instruction on the day before surgery. Pressure and mask are tested by trained personnel at the Lung section so that both pressure and mask are comfortable and can be tolerated by the patient. Immediately after surgery they will be given CPAP for at least 2 hours immediately after surgery and during the first two postoperative nights. Oxygen is supplied to CPAP if oxygen saturation falls below 90%.

Patients in the control group receive standard treatment and supplemental oxygen if oxygen saturation falls below 90%

Included in a third arm are patients who already are using CPAP at night at home for previously diagnosed obstructive sleep apnea. They are instructed to use CPAP for 2 hours immediately after surgery and subsequent nights during hospital stay.

Conditions

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Abdominal Surgery Continuous Positive Airway Pressure Lung Function

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Control

Regular treatment

Group Type NO_INTERVENTION

No interventions assigned to this group

Auto CPAP

Auto CPAP, AirSense 10 AutoSet, ResMed Inc, max pressure 10 cm water, min pressure 5 cm water

Group Type EXPERIMENTAL

Auto-CPAP

Intervention Type DEVICE

AIrSense 10, Auto-CPAP, Minimum pressure 5 cm water, maximum pressure 10 cm water

CPAP since before

Patients with CPAP since before will all continue using CPAP. They will not attend the randomization process. They will be regarded as a separate group.

Group Type OTHER

CPAP since before

Intervention Type DEVICE

A CPAP the patient uses since before because of previously diagnosed obstructive sleep apnea

Interventions

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Auto-CPAP

AIrSense 10, Auto-CPAP, Minimum pressure 5 cm water, maximum pressure 10 cm water

Intervention Type DEVICE

CPAP since before

A CPAP the patient uses since before because of previously diagnosed obstructive sleep apnea

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Adults (age 18-80 years) scheduled for elective abdominal surgery
* Must be able to tolerate nasal CPAP

Exclusion Criteria

* American Society Anesthesia (ASA) Class 3-4.
* Cognitive impairment or dementia
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Umeå University

OTHER

Sponsor Role lead

Responsible Party

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Karl A Franklin

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Karl A Franklin, Prof

Role: PRINCIPAL_INVESTIGATOR

Department of Surgery

Locations

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Dept of Surgery, Inst of Surgical and Perioperative sciences

Umeå, Umea, Sweden

Site Status

Countries

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Sweden

Central Contacts

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Karl A Franklin, Prof

Role: CONTACT

Phone: +46 706884745

Email: [email protected]

Other Identifiers

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2020-03408

Identifier Type: -

Identifier Source: org_study_id