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Набор скоро начнётся NCT07638176

Effect of Individualized Positive End-expiratory Pressure (PEEP) in Patients Who Have an Intrinsic PEEP During One-lung Ventilation

Без фазы С лечением Pulmonary Disease (COPD), Chronic Obstructive Lung Resection Surgery

Ориентир для пациента и семьи

Простыми словами

Автоматическая сводка по структурированным данным реестра. Она помогает сориентироваться, но не заменяет официальный протокол или оценку врача.

Что изучают
В протоколе указаны: PEEP0, PEEP5, PEEPi.
Кому может быть актуально
Состояния в реестре: Pulmonary Disease (COPD), Chronic Obstructive, Lung Resection Surgery. Базовые параметры: 19 лет — 100 лет · Все.
Что важно проверить
Возраст, диагноз и пол — только базовые ориентиры. Предыдущее лечение, анализы и другие обязательные условия указаны ниже в критериях участия.
Где проводится
Список центров уточняется — проверьте первичный протокол.
Следующий шаг
Сохраните исследование, покажите его лечащему врачу и уточните актуальный статус у исследовательского центра. Расходы, документы и поездка →

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Официальное название

Effects of Individualized Positive End-expiratory Pressure (PEEP) on Intrinsic PEEP and Stroke Volume During One-lung Ventilation: a Single-center, Randomized Crossover Study

Обзор

This study investigates the effects of three extrinsic PEEP settings-5 cmH2O, 0 cmH2O, and an individualized PEEP (70% of the measured intrinsic PEEP)-on intrinsic PEEP and hemodynamic stability in patients with intrinsic PEEP undergoing lung resection surgery, using a randomized, crossover design.

Подробное описание

Intrinsic positive end-expiratory pressure (iPEEP) frequently occurs during one-lung ventilation (OLV), which is essential for lung resection. This occurrence is driven by three primary factors. First, a significant portion of patients undergoing lung surgery have concomitant chronic obstructive pulmonary disease (COPD) and thus possess a baseline intrinsic PEEP. Second, high-frequency ventilation applied to prevent carbon dioxide accumulation during OLV shortens the expiratory time, thereby generating intrinsic PEEP. Third, the use of a narrow-bore double-lumen endobronchial tube for OLV increases airway resistance, accelerating the development of intrinsic PEEP. Intrinsic PEEP causes lung hyperinflation and elevates intrathoracic pressure, which can subsequently decrease venous return and lead to abrupt hypotension. However, research remains insufficient regarding the optimal level of extrinsic PEEP for patients who develop intrinsic PEEP during OLV. While an extrinsic PEEP of around 5 cmH2O is generally applied during OLV, some guidelines recommend completely removing extrinsic PEEP (0 cmH2O) during OLV in COPD patients. Nevertheless, this recommendation lacks robust scientific evidence. Furthermore, whether the strategy of setting extrinsic PEEP at approximately 70% of intrinsic PEEP-as suggested by studies in critically ill patients-is equally valid in the intraoperative OLV environment remains unverified. Theoretically, if extrinsic PEEP exceeds intrinsic PEEP, it may exacerbate lung hyperinflation by increasing expiratory resistance. Conversely, an extrinsic PEEP that is too low may cause airway collapse during expiration, paradoxically worsening gas trapping. Therefore, this study aims to evaluate the effects of three extrinsic PEEP settings-5 cmH2O, 0 cmH2O, and an individualized PEEP (70% of the measured intrinsic PEEP)-on intrinsic PEEP and hemodynamic stability using a randomized, crossover design.

Вмешательства

  • Процедура PEEP0
    PEEP 0 (zero) means off-PEEP on the anesthesia machine.
  • Процедура PEEP5
    PEEP5 means setting the PEEP to 5 cmH2O on the anesthesia machine.
  • Процедура PEEPi
    PEEPi (individualized PEEP) means setting the PEEP to 70% of intrinsic PEEP on the anesthesia machine.

Первичные конечные точки

  • Intrinsic positive end-expiratory airway pressure [Срок оценки: During a 30-minute period from the start of one-lung ventilation to the completion of the intervention]
  • Stroke volume [Срок оценки: During a 30-minute period from the start of one-lung ventilation to the completion of the intervention]

Критерии участия

Критерии включения

  • American Society of Anesthesiologists Physical Status I - III
  • The Eastern Cooperative Oncology Group Performance Status Grade 0 - 2
  • Lung resection surgery requiring one-lung ventilation for over 60 minutes
  • Indication of double-lumen endobronchial tube (female 35 Fr, male 37 Fr)
  • Patient who is diagnosed with intrinsic PEEP during one-lung ventilation

Критерии исключения

  • Large bullae
  • Emergency surgery
  • Mechanical ventilation before surgery
  • Hemodynamic instability before surgery
  • Surgery requiring cardiopulmonary bypass
  • Pregnancy, breastfeeding patient
  • Patient's refusal to participate
  • No intrinsic PEEP during one-lung ventilation

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение
Не применимо
Модель
Одна группа
Маскирование
Открытое
Основная цель
Лечение

Центры проведения

Список центров уточняется — проверьте первичный протокол.

Идентификаторы

NCT: NCT07638176 · Individual PEEP trial

Первоисточники (государственные реестры)

Открыть это исследование на ClinicalTrials.gov ↗