Individual Optimal Positive End-expiratory Pressure During Robot-assisted Laparoscopic Radical Prostatectomy

Seoul National University

Status: Completed

Conditions: Pulmonary Atelectasis, Postoperative

Treatments: Procedure: Individualized optimal positive end-expiratory pressure; Procedure: Conventional positive end-expiratory pressure

Study type: Interventional

Funder types: Other

Identifiers

NCT04085146

1908-022-105

Details and patient eligibility

About

During robot-assisted radical prostatectomy, pneumoperitoneum with Trendelenburg position is used. However, perioperative atelectasis and respiratory complications may occur with high incidence due to general anesthesia and carbon dioxide pneumoperitoneum. Intraoperative ventilatory strategy to address these issues include intraoperative recruitment maneuver and positive end-expiratory pressure (PEEP). Recently, individualized optimal PEEP with minimal driving pressure or maximal respiratory compliance was reported to reduce respiratory complications after general anesthesia. A recent version of general anesthesia ventilator provides a stepwise procedure of determining optimal PEEP by calculating respiratory compliance. We investigated whether the application of individualized optimal PEEP could reduce the incidence of atelectasis and respiratory complications after robot-assisted laparoscopic radical prostatectomy compared to uniform PEEP.

Full description

During robot-assisted radical prostatectomy, pneumoperitoneum with Trendelenburg position is used. However, perioperative atelectasis and respiratory complications may occur with high incidence due to general anesthesia and carbon dioxide pneumoperitoneum. Intraoperative ventilatory strategy to address these issues include intraoperative recruitment maneuver and positive end-expiratory pressure (PEEP). Recently, individualized optimal PEEP with minimal driving pressure or maximal respiratory compliance was reported to reduce respiratory complications after general anesthesia. A recent version of general anesthesia ventilator provides a stepwise procedure of determining optimal PEEP by calculating respiratory compliance. We investigated whether the application of individualized optimal PEEP could reduce the incidence of atelectasis and respiratory complications after robot-assisted laparoscopic radical prostatectomy compared to uniform PEEP. We plan to determine the degree of immediate postoperative atelectasis by measuring the lung ultrasound score and compare the lung ultrasound score between groups.

Enrollment: 60 patients

Sex: Male

Ages: 20+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients undergoing robot-assisted laparoscopic radical prostatectomy
• Patients receiving mechanical ventilation by Aisys Care Station anesthesia ventilator
• Patients who provided written informed consent to participate in this clinical trial

Exclusion criteria

• American Society of Anesthesiologists physical status classification class 3 or more
• Moderate or more obstructive or restrictive pulmonary disease
• Preoperative adult respiratory distress syndrome or previous history of adult respiratory distress syndrome
• history of heart failure, unstable angina, increased intracranial pressure
• history of pneumothorax or presence of bullae

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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60 participants in 2 patient groups

Optimal PEEP

Experimental group

Description:

Individualized optimal PEEP will be provided during the laparoscopic period of surgery. Optimal PEEP will be determined by the automated procedure of step-wised decrease in the amount of PEEP of the anesthesia ventilator Aisys Care Station (GE Healthcare, Madison, Wisconsin, USA).

Treatment:

Procedure: Individualized optimal positive end-expiratory pressure

Conventional PEEP

Active Comparator group

Description:

A same amount of PEEP of 7 centimeter hydrogen dioxide will be provided during the laparoscopic period of surgery.

Treatment:

Procedure: Conventional positive end-expiratory pressure