The Effect of Semi-recumbent Position on Hypoxemia After Lung Segment/Lobe Surgery

NCT ID: NCT07060625

Last Updated: 2025-07-11

Basic Information

• Recruitment Status: ENROLLING_BY_INVITATION
• Total Enrollment: 308 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2024-12-23
• Study Completion Date: 2026-09-30

Brief Summary

Thoracoscopic surgery is the most common surgical approach in thoracic surgery, which reduces surgical trauma and postoperative pain compared with open thoracotomy, but postoperative complications should not be overlooked, with hypoxemia being particularly prominent. Postoperative hypoxemia is highly prevalent among patients recovering from non-cardiac surgery, accounting for over one-third of all cases. Hypoxemia impairs wound healing and leads to other severe complications such as cerebral dysfunction, arrhythmia, and myocardial ischemia, all of which adversely affect postoperative recovery. Although oxygen therapy can prevent and treat hypoxemia, many patients still experience hypoxia in the post-anesthesia care unit (PACU). Numerous studies have investigated various ventilation techniques aimed at enhancing postoperative pulmonary function, but the benefits of protective ventilation strategies may be lost during emergence from anesthesia. Several other studies also indicate that intraoperative ventilation measures do not improve postoperative pulmonary function. The lack of evidence demonstrating the efficacy of oxygen therapy or protective ventilation techniques in treating postoperative hypoxemia underscores the need to explore alternative strategies. Patient positioning during emergence from anesthesia is associated with perioperative and postoperative complications. Although no consensus exists on the optimal patient position during emergence, the supine position is often favored by anesthesiologists due to its simplicity and ease of monitoring. However, the reduced functional residual capacity associated with the supine position tends to promote airway closure and diminish gas exchange.

Detailed Description

Thoracoscopic surgery is the most common surgical approach in thoracic surgery, which reduces surgical trauma and postoperative pain compared with open thoracotomy, but postoperative complications should not be overlooked, with hypoxemia being particularly prominent. Postoperative hypoxemia is highly prevalent among patients recovering from non-cardiac surgery, accounting for over one-third of all cases. Hypoxemia impairs wound healing and leads to other severe complications such as cerebral dysfunction, arrhythmia, and myocardial ischemia, all of which adversely affect postoperative recovery. Although oxygen therapy can prevent and treat hypoxemia, many patients still experience hypoxia in the post-anesthesia care unit (PACU). Numerous studies have investigated various ventilation techniques aimed at enhancing postoperative pulmonary function, but the benefits of protective ventilation strategies may be lost during emergence from anesthesia. Several other studies also indicate that intraoperative ventilation measures do not improve postoperative pulmonary function. The lack of evidence demonstrating the efficacy of oxygen therapy or protective ventilation techniques in treating postoperative hypoxemia underscores the need to explore alternative strategies. Patient positioning during emergence from anesthesia is associated with perioperative and postoperative complications. Although no consensus exists on the optimal patient position during emergence, the supine position is often favored by anesthesiologists due to its simplicity and ease of monitoring. However, the reduced functional residual capacity associated with the supine position tends to promote airway closure and diminish gas exchange. In contrast, the semi-recumbent position (SRP) has been shown to increase vital capacity by 10% to 15%, enhance functional lung volume and residual capacity, and improve diaphragmatic range of motion, thereby promoting lung expansion and gas exchange. Currently, only one study has found that in patients undergoing laparoscopic-assisted upper abdominal surgery, 30° SRP during anesthesia recovery can reduce the incidence of postoperative hypoxemia. Therefore, we conducted this real-world study to test the efficacy and optimal tilt angle of SRP in reducing hypoxemia during anesthesia recovery in a large sample of patients undergoing thoracoscopic surgery.

Conditions

Lung Cancer (Diagnosis); Hypoxemia

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

Exposure group

Semi-recumbent position during anesthesia recovery

Semi-reclining position

Intervention Type: BEHAVIORAL

During anesthesia recovery, the patient's position should be in a semi-recumbent position

Non exposed group

Supine position during anesthesia recovery

No interventions assigned to this group

Interventions

Semi-reclining position

During anesthesia recovery, the patient's position should be in a semi-recumbent position

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• Age 18-85 years old; Undergo thoracoscopic segment/lobectomy; American Society of Anesthesiologists (ASA) grade 1~3

Exclusion Criteria

• Patients with mental or cognitive dysfunction who cannot communicate normally; Patients with tracheal catheters retained in ICU; Patients with cervical spondylosis, ankylosing spondylitis and other patients who cannot lift their upper body; Patients who have participated in other clinical trials; Patients who refuse to sign informed consent; Patients who have had chest surgery in the past.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 85 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Shanghai Pulmonary Hospital, Shanghai, China

OTHER

Sponsor Role: lead

Responsible Party

Hao Yang

post-doctoral

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Yang Hao, postdoctor

Role: STUDY_DIRECTOR

Locations

Shanghai Pulmonary Hospital

Shanghai, Shanghai Municipality, China

Countries

China

Other Identifiers

L24-629

Identifier Type: -

Identifier Source: org_study_id