Optimal Level of PEEP in Protective One-lung Ventilation

Seoul National University

Status: Completed

Conditions: Video-assisted Thoracic Surgery; Positive End-expiratory Pressure; Postoperative Atelectasis

Treatments: Procedure: PEEP 9 cm of water; Procedure: PEEP 3 cm of water; Procedure: PEEP 6 cm of water

Study type: Interventional

Funder types: Other

Identifiers

NCT03856918

H-1901-086-1004

Details and patient eligibility

About

Protective ventilation strategy has been widely applied in the field of thoracic surgery requiring one-lung ventilation to reduce postoperative pulmonary complications. Low tidal volume, positive end-expiratory pressure (PEEP), and intermittent recruitment maneuver are key components of protective ventilation strategy. Recent evidence suggests that a tidal volume of 4-5 ml/kg should be applied during protective one-lung ventilation. However, optimal level of PEEP is still unclear. This study aims to investigate optimal level of PEEP to minimize postoperative atelectasis by comparing modified lung ultrasound score in patients applied protective one-lung ventilation using PEEP of 3, 6, or 9 cm of water during thoracic surgery.

Enrollment: 142 patients

Sex: All

Ages: 19 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients undergoing Video-assisted Thoracic Surgery under one-lung ventilation

Exclusion criteria

• Moderate to severe obstructive/restrictive pattern in preoperative pulmonary function test
• Chronic kidney disease
• Coronary artery disease
• Pulmonary hypertension
• Bilateral lung surgery
• Conversion to thoracotomy
• American Society of Anesthesiologists physical status IV or more
• Refusal to participate

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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142 participants in 3 patient groups

PEEP 3 cm of water

Experimental group

Description:

Patients allocated in this group will be applied protective one-lung ventilation using tidal volume of 5 ml/kg predicted body weight with PEEP of 3 cm of water during thoracic surgery.

Treatment:

Procedure: PEEP 3 cm of water

PEEP 6 cm of water

Experimental group

Description:

Patients allocated in this group will be applied protective one-lung ventilation using tidal volume of 5 ml/kg predicted body weight with PEEP of 6 cm of water during thoracic surgery.

Treatment:

Procedure: PEEP 6 cm of water

PEEP 9 cm of water

Experimental group

Description:

Patients allocated in this group will be applied protective one-lung ventilation using tidal volume of 5 ml/kg predicted body weight with PEEP of 9 cm of water during thoracic surgery.

Treatment:

Procedure: PEEP 9 cm of water