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To observe the effectiveness of ultrasound-guided alveolar recruitment in thoracic surgery with one-lung ventilation(OLV).
One-lung ventilation(OLV) is essential in thoracic surgery for patient safety and better surgical view. However, pulmonary complications such as hypoxemia may be caused by OLV which might be preventable with adequate alveolar recruitment and positive end-expiratory pressure(PEEP). Alveolar recruitment has been performed with conventional methods without diagnostic tools in clinical setting.
Ultrasound is a non-invasive, radiation-free device with high accuracy for the diagnosis of lung atelectasis. There are a few reports regarding the usefulness of lung ultrasound in other surgeries, but not in thoracic surgeries with OLV.
Thus, investigators designed a study to observe the effectiveness of ultrasound-guided alveolar recruitment in thoracic surgery with OLV.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Lung-sono guided | Experimental | Before starting one-lung ventilation, alveolar recruitment is performed under the examination with ultrasound. Find the minimal airway pressure that actually starts to resolve the observed atelectasis. Repeat alveolar recruitment with the minimal pressure untill the atlelectasis is not visible. |
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| Conventional | No Intervention | Before starting one-lung ventilation, alveolar recruitment is performed with the pressure of 30mmHg for 10 seconds which is a conventional method. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Lung-sono guided | Procedure | The patient undergoing thoracic surgery is intubated with double lumen tube after induction of general anesthesia with propofol and remifentanil. In the intervention group, alveolar recruitment is performed to the non-surgical side of lung under examination with ultrasound just after anesthesia induction. During the gradual increment in the pressure of recruitment, the anesthesiologist can find the opening pressure that means the minimal pressure at which observed atelectasis starts to disappear. Then, alveolar recruitment is performed with the opening pressure until the atelectasis is not visible. |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of desaturation | SpO2<95% | intraoperative |
| P/F ratio | PaO2/FiO2 ratio | 30 minutes after one-lung ventilation |
| Measure | Description | Time Frame |
|---|---|---|
| Lung ultrasound score | Lung ultrasound score of atelectasis | just after anesthesia induction, end of surgery |
| Alveolar dead space | (PaCO2-PetCO2)xVt/PaCO2 |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jeong-Hwa Seo, PhD | Seoul National University Hospital | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Seoul National University Hospital | Seoul | South Korea |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29309282 | Background | Song IK, Kim EH, Lee JH, Kang P, Kim HS, Kim JT. Utility of Perioperative Lung Ultrasound in Pediatric Cardiac Surgery: A Randomized Controlled Trial. Anesthesiology. 2018 Apr;128(4):718-727. doi: 10.1097/ALN.0000000000002069. | |
| 40581064 | Derived | Kim BR, Lim L, You J, Yoon S, Park JB, Bahk JH, Seo JH. Effectiveness of ultrasound-guided alveolar recruitment in thoracic surgery with one-lung ventilation: a randomized-controlled trial. Eur J Cardiothorac Surg. 2025 Jul 1;67(7):ezaf204. doi: 10.1093/ejcts/ezaf204. |
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|
| 30 minutes after one-lung ventilation |
| Pulmonary complications | respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, atelectasis, bronchospasm, aspiration pneumonitis | intraoperative, during hospital stay(an average of 3 days) |