Track topics on Twitter Track topics that are important to you
Compared with the information available in sepsis and trauma-associated ARDS, less is known about the cause and pattern of lung injury after thoracic surgery. Definition of lung injury in this context is difficult. Most now use the joint North American-European consensus conference definitions, but these are based only on gas exchange and radiology criteria. While gas exchange measures are reliable, thoracotomy inevitably causes radiological change and the interpretation of plain chest films becomes subjective. Definitions based on permeability and inflammatory changes would improve diagnosis, but are not routinely available in most units.
Pressure-controlled volume (PCV) may be useful to improve gas exchange and alveolar recruitment with associated lower airway pressures and shunt fraction during one-lung ventilation (OLV).
However, a recent prospective randomized study of the effects of PCV during OLV did not lead to improved oxygenation during OLV compared with VCV, but PCV did lead to lower peak airway pressures. To date, there are no reports of the effects of PCV versus VCV during OLV on the acute lung injury (ALI) after thoracotomy.
We hypothesize that the use of PCV during OLV for thoracic surgery may improve the anti-inflammatory immunoregulation than VCV. It may attenuate the increases in proinflammatory cytokines, including interleukins (IL-8, IL-1, and IL-6) and TNF-α, and prevent suppression of the anti-inflammatory cytokine (IL-10) secretion.
The aims of the present study are:
Our research efforts will focus on identifying the effects of PCV vs.VCV during OLV for thoracotomy on the followings.
1. Intraoperative changes in the peak and plateau airway pressures and static and dynamic lung compliance.
2. Pulmonary function tests [vital capacity and FEV1] and arterial blood gases changes during the first 3 postoperative days.
3. The perioperative changes in serum levels of the proinflammatory cytokines, including IL-1, IL-6, IL8, and TNF-α and the anti-inflammatory cytokines IL-10,
4. The perioperative changes in BAL levels of the concentration of proteins, IL-1, IL-6, IL8, IL-10, and TNF-α.
5. The duration of postoperative ventilatory support, the time to extubation, the length of stay in post-anaesthesia care unit (PACU).
6. The incidence of the major complications (respiratory failure, cardiovascular events, bleeding, and renal dysfunction).
This prospective randomized placebo-controlled blinded study will be carried out from at the Cardiothoracic Surgery Unit - King Fahd University Hospital, after approval of the Institutional Ethical Committee.
Study Phases: The project comprised of five phases as follow:
• Phase I: Literature review collection and writing which will spend 2 months.
• Phase II: Pilot Study for 2 months to determine changes in the serum levels of cytokines to test the power of the study to define the proper sample size for both the VCV and PCV group during OLV.
• Phase III: A. Thoracic procedures using one-ling ventilation techniques: Arterial blood gases, chest X- ray, pulmonary function tests, liver function tests, CPK, samples collection [serum and BAL] and laboratory testing for cytokine changes.
B. Recording of the Clinical Outcome: included the times of ventilation, extubation, ICU and hospital stay, mortality and morbidity.
The study will be conducted in the OR suite and ICU at the King Fahd Hospital of the University - Alkhubar Study period: For 6 months. I. Patient Selection: patients aged 18-60 years (ASA physical status II-III) scheduled for elective open thoracic surgery using one lung ventilation for periods longer than 1.5 h will be allocated randomly to two groups by drawing of sequentially numbered sealed opaque envelopes that each contained a computer-generated randomization code. We will exclude the patients with decompensated cardiac (>New York Heart Association II), pulmonary diseases (VC or FEV1<50% of the predicted values), pulmonary hypertension (mean pulmonary artery pressure [MPAP] >30 mm Hg), and previous lobectomy or bilobectomy in the medical history, those treated with immune modulators (cytostatic drugs, corticosteroids and non-steroidal anti-inflammatory drugs, vaccination, blood products), within 3 months before surgery and with symptoms of an acute inflammatory process (clinically defined or abnormal data for C-reactive protein, leukocyte count, or body temperature).
II. Patient Groups and Study Protocol: Volume-controlled ventilation [VCV] group (n=according to the power of the study): patients' lungs will ventilated with a tidal volume of 8 ml.kg-1. Pressure-controlled ventilation [PCV] group (n=as before) patients' lungs ventilation will be initiated with a peak airway pressure that provided a tidal volume of 8 ml.kg-1. R.R will be adjusted to achieve an arterial PaCO2 4.5-6 kPa and FiO2 will be increased to 1.0 during OLV. All staff in the operating room, ICU and the ward will be unaware of the randomization code.
III. Anesthesia and Surgery: The patients will undergo combined thoracic epidural analgesia and general anesthesia using one lung ventilation technique for open thoracic surgical procedures through a standard posterolateral or an anterolateral muscle-sparing thoracotomy by the same consultants.
IV. The Investigators who will be involved with subsequent postoperative patient assessment will be blinded of the patient group.
V. Clinical Examination: included the intraoperative changes in airway pressures and lung compliances and the perioperative changes in pulmonary function tests [vital capacity and FEV1], the duration of postoperative ventilatory support, the time to extubation, the length of stay in PACU, the incidence of any major complications (respiratory failure, cardiovascular events, bleeding, and renal dysfunction).
VI. Blood Biochemistry: included the perioperative changes in arterial blood gases.
VII. Samples Collection and Analysis For the Inflammatory Mediators: The perioperative changes in serum levels of the concentration of the cytokines IL-1, IL-6, IL8, IL-10, and TNF-α, and the perioperative changes in BAL levels of the concentration of proteins, IL-1, IL-6, IL8, IL-10, and TNF-α.
1. . Type of samples: centrifuged stored aliquots of serum at -70°C and Supernatant frozen (at -80°C) broncho-alveolar lavage (BAL) aliquots.
2. . Laboratory Analysis:
1. Cytokine determinations on the BAL fluid and plasma will be carried out using a solid-phase enzyme-linked immunosorbent assay method based on the quantitative immunometric sandwich enzyme immunoassay technique (Quantikine®; R&D Systems Ltd., Abingdon, UK).
2. TNF-α immunoassay will be provided by Immunotech, France. Protein concentrations will be measured by an assay for the colorimetric detection and quantitation of total protein (Micro BCA TM Protein Assay Reagent Kit; Pierce, Rockford, IL).
3. All samples of one patient will be analyzed in the same assay run.
4. The samples will be measured in duplicates and the assays will be performed according to the manufacturer's instructions.
5. The optical density of the samples will be determined by a microplate reader (Safire®; Tecan Ltd., Salzburg, Austria) and will be analyzed using the Safire microplate reader software by interpolation from standard curves. The sensitivities of the test kits are as follows: IL-1: 10 pg.mL-1, IL-6: 10 pg.mL-1, IL-8: 3.5 pg.mL-1, IL-10: 0.5 pg.mL-1, TNF : 5 pg.mL-1, protein: 0.5 µg.mL-1.
IV. Statistical Analysis: 2months Statistical analysis will be performed using the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL). Data will be tested for normality using Kolmogorov-Smirnov test. An unpaired Student's t test will be used to compare the parametric values of the two groups; Mann-Whitney U test will be performed to compare the non-parametric values of the two groups. Serial changes in peri-operative data at the start of the treatment will be analyzed with repeated measures analysis of variance. PFTs variables and cytokine changes at different times within groups will be analysed with repeated measure analysis of variance (Anova test). Data will be expressed as mean (SD), number (%) or (median [range]). A value of P<0.05 will be considered to represent statistical significance.
V.Report Writing:2 months
Allocation: Randomized, Control: Active Control, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment
Pressure Controlled vs. Volume Controlled Ventilation during OLV
King Fahd Hospital of the University
King Faisal University
Published on BioPortfolio: 2014-07-24T14:11:34-0400
It is controversial as to which ventilation mode is better in one-lung ventilation(OLV), volume controlled ventilation(VCV) or pressure controlled ventilation(PCV). This study was designed...
To assess the potential benefits on mechanical ventilation plateau pressure of pressure controlled mode versus volume controlled mode for laparoscopic bariatric surgery in obese patients (...
Volume controlled ventilation(VCV) is a most common used ventilation mode during general anesthesia. But VCV can cause high airway peak pressure when patient under steep Trendelenberg posi...
The anesthetized patient is turned to the prone position during lumbar spine surgery. The dynamic compliance of lung usually decreases and peak airway pressure increases during the surgery...
Volume controlled ventilation (VCV) and pressure controlled ventilation (PCV) are the common ventilatory modes during OLV undergoing thoracic surgery. A controversy regarding which ventila...
The objective of the present study was to explore the effects of different one-lung ventilation (OLV) modes on lung function in elderly patients undergoing esophageal cancer surgery. A total of 180 co...
Pressure-controlled inverse inspiratory to expiratory ratio ventilation (PC-IRV) is thought to be beneficial for reducing the dead space volume.
Paravertebral block (PVB) has been proven to be an efficient way to control postoperative pain in patients who have undergone a thoracotomy. This study aimed to explore whether the utilization of a pa...
Techniques for effecting the transition of the respiratory-failure patient from mechanical ventilation to spontaneous ventilation, while meeting the criteria that tidal volume be above a given threshold (greater than 5 ml/kg), respiratory frequency be below a given count (less than 30 breaths/min), and oxygen partial pressure be above a given threshold (PaO2 greater than 50mm Hg). Weaning studies focus on finding methods to monitor and predict the outcome of mechanical ventilator weaning as well as finding ventilatory support techniques which will facilitate successful weaning. Present methods include intermittent mandatory ventilation, intermittent positive pressure ventilation, and mandatory minute volume ventilation.
Implanted fluid propulsion systems with self-contained power source for providing long-term controlled-rate delivery of drugs such as chemotherapeutic agents or analgesics. Delivery rate may be externally controlled or osmotically or peristatically controlled with the aid of transcutaneous monitoring.
Procedure in which arterial blood pressure is intentionally reduced in order to control blood loss during surgery. This procedure is performed either pharmacologically or by pre-surgical removal of blood.
A method of mechanical ventilation in which pressure is maintained to increase the volume of gas remaining in the lungs at the end of expiration, thus reducing the shunting of blood through the lungs and improving gas exchange.
A surgical specialty concerned with diagnosis and treatment of disorders of the heart, lungs, and esophagus. Two major types of thoracic surgery are classified as pulmonary and cardiovascular.
Sepsis, septicaemia and blood poisoning
Septicaemia (another name for blood poisoning) refers to a bacterial infection of the blood, whereas sepsis can also be caused by viral or fungal infections. Sepsis is not just limited to the blood and can affect the whole body, including the organ...
Pulmonary relating to or associated with the lungs eg Asthma, chronic bronchitis, emphysema, COPD, Cystic Fibrosis, Influenza, Lung Cancer, Pneumonia, Pulmonary Arterial Hypertension, Sleep Disorders etc Follow and track Lung Cancer News ...