Driving Pressure During General Anesthesia for Minimally Invasive Abdominal Surgery (GENERATOR)

NCT ID: NCT06101511

Last Updated: 2025-01-30

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

RECRUITING

Clinical Phase

NA

Total Enrollment

1806 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-12-11

Study Completion Date

2027-09-01

Brief Summary

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The purpose of this international multicenter, patient and outcome-assessor blinded randomized controlled trial is to determine whether the application of an individualized high Positive End Expiratory Pressure (PEEP) strategy with recruitment maneuvers, aiming at avoiding an increase in the driving pressure during intraoperative ventilation, protects against the development of postoperative pulmonary complications in patients undergoing minimally invasive abdominal surgery.

Detailed Description

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Conditions

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Postoperative Complications Surgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Individualized high PEEP strategy with recruitment maneuvers

The intervention is intraoperative ventilation using the available ventilator with individualized high positive end-expiratory pressure (PEEP) titrated to the lowest driving pressure (ΔP) with recruitment maneuvers (RMs). After abdominal insufflation, patients randomized to the individualized high PEEP with RMs group will receive a RM followed by a 'decremental PEEP trial'. This is followed by a second RM after which PEEP is set at the level indicated by the decremental PEEP trial.

Group Type EXPERIMENTAL

Intraoperative ventilation with individualized high PEEP titrated to the lowest ΔP with RMs

Intervention Type PROCEDURE

The intervention is intraoperative ventilation using the available ventilator with individualized high PEEP titrated to the lowest ΔP with RMs. After abdominal insufflation, patients randomized to the individualized high PEEP with RMs group will receive a RM followed by a 'decremental PEEP trial'. This is followed by a second RM after which PEEP is set at the level indicated by the decremental PEEP trial

Standard low PEEP strategy without recruitment maneuvers

Patients randomized to the standard low PEEP group will receive 5 cm H2O PEEP for the complete duration of general anesthesia. They will neither receive one of the planned RMs nor a decremental PEEP trial.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Intraoperative ventilation with individualized high PEEP titrated to the lowest ΔP with RMs

The intervention is intraoperative ventilation using the available ventilator with individualized high PEEP titrated to the lowest ΔP with RMs. After abdominal insufflation, patients randomized to the individualized high PEEP with RMs group will receive a RM followed by a 'decremental PEEP trial'. This is followed by a second RM after which PEEP is set at the level indicated by the decremental PEEP trial

Intervention Type PROCEDURE

Other Intervention Names

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Individualized high PEEP strategy with recruitment maneuvers

Eligibility Criteria

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Inclusion Criteria

1. age \> 18 years; AND
2. scheduled for minimally invasive abdominal surgery; AND
3. at increased (i.e., intermediate or high) risk of PPCs according to the 'Assess Respiratory risk in Surgical Patients in Catalonia' (ARISCAT) risk score (≥ 26 points, see Appendix I); OR at increased risk of PPCs based on the combination of age \> 40 years, scheduled surgery lasting \> 2 hours and planned to receive an intra-arterial catheter for blood pressure monitoring during the surgery; AND
4. signed written informed consent

Exclusion Criteria

1. planned for open abdominal surgery;
2. planned for surgery in lateral or prone position;
3. planned for combined abdominal and intra-thoracic surgery
4. confirmed pregnancy;
5. consent for another interventional trial during anesthesia;
6. having received invasive ventilation \> 30 minutes within the last five days;
7. any previous lung surgery;
8. history of previous severe chronic obstructive pulmonary disease (COPD) with (noninvasive) ventilation or oxygen therapy at home or repeated systemic corticosteroid therapy for acute exacerbations of COPD;
9. history of acute respiratory distress syndrome (ARDS);
10. expected to require postoperative ventilation;
11. expected hemodynamic instability or intractable shock;
12. severe cardiac disease (New York Heart Association class III or IV, acute coronary syndrome or persistent ventricular tachyarrhythmia's).
Minimum Eligible Age

18 Years

Maximum Eligible Age

100 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Onze Lieve Vrouwe Gasthuis

OTHER

Sponsor Role collaborator

HagaZiekenhuis

OTHER

Sponsor Role collaborator

Dijklander Ziekenhuis

OTHER

Sponsor Role collaborator

The Netherlands Cancer Institute

OTHER

Sponsor Role collaborator

Isala

OTHER

Sponsor Role collaborator

Maasstad Hospital

OTHER

Sponsor Role collaborator

Medisch Spectrum Twente

OTHER

Sponsor Role collaborator

University Medical Center Groningen

OTHER

Sponsor Role collaborator

Leiden University Medical Center

OTHER

Sponsor Role collaborator

Hospital Universitario La Fe

OTHER

Sponsor Role collaborator

Ospedale Policlinico San Martino

OTHER

Sponsor Role collaborator

University Hospital Carl Gustav Carus

OTHER

Sponsor Role collaborator

Medical University Innsbruck

OTHER

Sponsor Role collaborator

Spaarne Gasthuis

OTHER

Sponsor Role collaborator

Zaans Medical Center

OTHER

Sponsor Role collaborator

Alrijne Hospital

OTHER

Sponsor Role collaborator

Albert Schweitzer Hospital

OTHER

Sponsor Role collaborator

Maastricht University Medical Center

OTHER

Sponsor Role collaborator

Noordwest Ziekenhuisgroep

OTHER

Sponsor Role collaborator

Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)

OTHER

Sponsor Role lead

Responsible Party

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Prof. Dr. Marcus J. Schultz

Professor of Intensive Care Medicine, Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Marcus Schultz, Professor

Role: STUDY_CHAIR

Amsterdam University Medical Center, location AMC

Markus Hollmann, Professor

Role: PRINCIPAL_INVESTIGATOR

Amsterdam University Medical Center, location AMC

David van Meenen, PhD

Role: PRINCIPAL_INVESTIGATOR

Amsterdam University Medical Center, location AMC

Sabrine Hemmes, PhD

Role: PRINCIPAL_INVESTIGATOR

Amsterdam University Medical Center, location AMC

Locations

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Amsterdam University Medical Center

Amsterdam, Noordholland, Netherlands

Site Status RECRUITING

Countries

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Netherlands

Central Contacts

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Tom Vermeulen, MD

Role: CONTACT

+ 31 020 566 2533

Galina Dorland, MD

Role: CONTACT

Facility Contacts

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Tom Vermeulen, Master

Role: primary

References

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GENERATOR-investigators. Driving pressure during general anesthesia for minimally invasive abdominal surgery (GENERATOR)-study protocol of a randomized clinical trial. Trials. 2024 Oct 26;25(1):719. doi: 10.1186/s13063-024-08479-x.

Reference Type DERIVED
PMID: 39456048 (View on PubMed)

Other Identifiers

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NL82971.018.23

Identifier Type: -

Identifier Source: org_study_id

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