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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PEEP 3 cm of water | Experimental | 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. |
|
| PEEP 6 cm of water | Experimental | 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. |
|
| PEEP 9 cm of water | Experimental | 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. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PEEP 3 cm of water | Procedure | PEEP of 3 cm of water will be applied during one-lung ventilation. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Modified lung ultrasound score | The score is calculated by adding up the 12 individual quadrant scores assessed using lung ultrasound. | Postoperative 1 hour |
| Measure | Description | Time Frame |
|---|---|---|
| Intraoperative desaturation | Oxygen saturation by pulse oximetry <95% during one-lung ventilation | Average time of 60-90 minutes |
| Intraoperative partial pressure of arterial oxygen/fraction of inspired oxygen ratio |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jae-Hyon Bahk, MD,PhD | Seoul National University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Seoul National University Hospital | Seoul | 110-744 | South Korea |
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| ID | Term |
|---|---|
| D011175 | Positive-Pressure Respiration |
| D014867 | Water |
| ID | Term |
|---|---|
| D012121 | Respiration, Artificial |
| D058109 | Airway Management |
| D013812 | Therapeutics |
| D012138 | Respiratory Therapy |
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| PEEP 6 cm of water | Procedure | PEEP of 6 cm of water will be applied during one-lung ventilation. |
|
| PEEP 9 cm of water | Procedure | PEEP of 9 cm of water will be applied during one-lung ventilation. |
|
partial pressure of arterial oxygen/fraction of inspired oxygen ratio during one-lung ventilation
| Average time of 60-90 minutes |
| Postoperative desaturation | Oxygen saturation by pulse oximetry <95% | Postoperative 24 hours |
| plasma Tumor Necrosis Factor-α | proinflammatory cytokine | 10 minutes after initiation of one-lung ventilation |
| plasma Interleukin-6 | proinflammatory cytokine | 10 minutes after initiation of one-lung ventilation |
| plasma Interleukin-10 | anti-inflammatory cytokine | 10 minutes after initiation of one-lung ventilation |
| Postoperative pulmonary complication | Composite outcome of atelectasis, pneumonia, acute respiratory distress syndrome, or pulmonary aspiration | Postoperative 7 days |
| D006878 |
| Hydroxides |
| D000468 | Alkalies |
| D007287 | Inorganic Chemicals |
| D000838 | Anions |
| D007477 | Ions |
| D004573 | Electrolytes |
| D010087 | Oxides |
| D017601 | Oxygen Compounds |