Driving Pressure During General Anesthesia for Open Abdominal Surgery

Driving Pressure During General Anesthesia for Open Abdominal Surgery (DESIGNATION) - a Randomized Clinical Trial

The purpose of this international multicenter, patient and outcome-assessor blinded randomized controlled trial is to determine whether the application of an individualized high PEEP strategy, aiming at avoiding an increase in the driving pressure during intraoperative ventilation, protects against the development of postoperative pulmonary complications.

Inclusion Criteria:

• Scheduled for open abdominal surgery
• High or intermediate risk for postoperative pulmonary complications according to ARISCAT score [J.Canet et al, Anesthesiology 2010;113]
• General anesthesia

Exclusion Criteria:

• Laparoscopic surgery
• Surgery in prone or lateral position
• Combined procedure with open abdominal and intrathoracic surgery
• Body mass index > 40 kg/m2;
• Reported pregnancy;
• Mechanical ventilation > than 30 minutes (e.g., in cases of general anesthesia because of surgery) within last 30 days;
• Any major previous lung surgery;
• History of previous severe chronic obstructive pulmonary disease (COPD) GOLD III or IV, or with (noninvasive) ventilation and/or oxygen therapy at home;
• (previous) acute respiratory distress syndrome (ARDS);
• Expected to require postoperative mechanical ventilation;
• Persistent hemodynamic instability or intractable shock;
• Severe cardiac disease (New York Heart Association class III or IV, or acute coronary syndrome, or persistent ventricular tachyarrhythmia's);
• Consented for another interventional study during anesthesia or refusal to participate in the study