Effect of PEEP on Subdural Pressure, Optic Nerve Sheath Diameter, Lung Compliance and Brain Perfusion Pressure

Istanbul University

Status: Unknown

Conditions: Anesthesia, General; Supratentorial Neoplasms; Optic Nerve

Treatments: Procedure: PEEP variations

Study type: Interventional

Funder types: Other

Identifiers

NCT04316208

ST_18032020

Details and patient eligibility

About

We aim to determine the level of intraoperative PEEP that optimizes lung compliance without causing a rise in subdural pressure and if we can utilize optic nerve sheath diameter measurement as an indicator for ICP while optimizing lung compliance during supratentorial tumor surgeries.

Full description

Application of positive end-expiratory pressure (PEEP) during general anesthesia minimizes ventilation/perfusion mismatch, intraoperative atelectasis and postoperative pulmonary complications. PEEP application in intracranial surgeries is usually avoided due to the risk of raised intracranial pressure (ICP) leading to decreased cerebral perfusion pressure (CPP). Several studies examine the effects of PEEP on subdural pressure and CPP however none examine how lung compliance is affected at the same time. Ultrasound-guided measurement of optic nerve sheath diameter (ONSD) is an indirect indicator of raised ICP and there is limited literature on the correlation of ONSD and ICP during intracranial surgery. In this study, we aim to determine the level of intraoperative PEEP that optimizes lung compliance without causing a rise in subdural pressure and if we can utilize ONSD measurement as an indicator for ICP while optimizing lung compliance during supratentorial tumor surgeries.

Enrollment: 50 estimated patients

Sex: All

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Supratentorial tumor
• Elective surgery
• American Society of Anesthesiologist Class I, II or III

Exclusion criteria

• Midline shift more than 5 mm determined by intracranial imaging
• Initial subdural pressure higher than 20 mmHg
• Requiring intravenous mannitol or hypertonic saline treatment before dural opening
• Congestive heart failure
• Pulmonary hypertension
• Sepsis
• Hypovolemia
• Obstructive or restrictive lung disease

Trial design

Primary purpose: Diagnostic

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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50 participants in 1 patient group

Supratentorial tumor surgery

Experimental group

Description:

Patients undergoing elective supratentorial tumor surgery under general anesthesia will be ventilated with positive end-expiratory pressures of 0, 5 and 10 cmH2O after craniotomy.

Treatment:

Procedure: PEEP variations