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During robot-assisted radical prostatectomy, pneumoperitoneum with Trendelenburg position is used. However, perioperative atelectasis and respiratory complications may occur with high incidence due to general anesthesia and carbon dioxide pneumoperitoneum. Intraoperative ventilatory strategy to address these issues include intraoperative recruitment maneuver and positive end-expiratory pressure (PEEP). Recently, individualized optimal PEEP with minimal driving pressure or maximal respiratory compliance was reported to reduce respiratory complications after general anesthesia. A recent version of general anesthesia ventilator provides a stepwise procedure of determining optimal PEEP by calculating respiratory compliance. We investigated whether the application of individualized optimal PEEP could reduce the incidence of atelectasis and respiratory complications after robot-assisted laparoscopic radical prostatectomy compared to uniform PEEP.
During robot-assisted radical prostatectomy, pneumoperitoneum with Trendelenburg position is used. However, perioperative atelectasis and respiratory complications may occur with high incidence due to general anesthesia and carbon dioxide pneumoperitoneum. Intraoperative ventilatory strategy to address these issues include intraoperative recruitment maneuver and positive end-expiratory pressure (PEEP). Recently, individualized optimal PEEP with minimal driving pressure or maximal respiratory compliance was reported to reduce respiratory complications after general anesthesia. A recent version of general anesthesia ventilator provides a stepwise procedure of determining optimal PEEP by calculating respiratory compliance. We investigated whether the application of individualized optimal PEEP could reduce the incidence of atelectasis and respiratory complications after robot-assisted laparoscopic radical prostatectomy compared to uniform PEEP. We plan to determine the degree of immediate postoperative atelectasis by measuring the lung ultrasound score and compare the lung ultrasound score between groups.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Optimal PEEP | Experimental | Individualized optimal PEEP will be provided during the laparoscopic period of surgery. Optimal PEEP will be determined by the automated procedure of step-wised decrease in the amount of PEEP of the anesthesia ventilator Aisys Care Station (GE Healthcare, Madison, Wisconsin, USA). |
|
| Conventional PEEP | Active Comparator | A same amount of PEEP of 7 centimeter hydrogen dioxide will be provided during the laparoscopic period of surgery. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Individualized optimal positive end-expiratory pressure | Procedure | Optimal PEEP will be determined by the automated procedure of step-wised decrease in the amount of PEEP of the anesthesia ventilator Aisys Care Station (GE Healthcare, Madison, Wisconsin, USA). |
| Measure | Description | Time Frame |
|---|---|---|
| Difference in lung ultrasound score | Difference in postoperative lung ultrasound score and baseline lung ultrasound score | 10 min after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Baseline lung ultrasound score | A scoring system with a sum of the B-line score and consolidation score by lung ultrasound examination | 10 min before the start of anesthesia induction |
| Composite of respiratory complication |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Seoul National University Hospital | Seoul | 03080 | South Korea |
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Randomized controlled superiority trial with two arms of intervention.
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Anesthesia care-provider cannot be blinded. Surgeon and outcome assessor will be blinded to the group assignment.
| Conventional positive end-expiratory pressure | Procedure | A same amount of PEEP of 7 centimeter hydrogen dioxide will be provided during the laparoscopic period of surgery. |
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summation of the following events: hypoxemia (pulse oximetry of 95% or less), laryngospasm, bronchospasm, pneumonia, pulmonary infiltration, aspiration pneumonia, pneumonia), pulmonary infiltration, aspiration pneumonia, development of acute respiratory distress syndrome, atelectasis, pleural effusion, pulmonary edema, pneumothorax.
| during postoperative seven days. |
| Length of hospital stay | Length of total hospital stay | during the postoperative one month |
| Postoperative Lung ultrasound score | A scoring system with a sum of the B-line score and consolidation score by lung ultrasound examination | 10 min after the end of anesthesia |
| Length of intensive care unit stay | Length of total hospital stay | during the postoperative one month |
| Surgical wound infection | The rate of surgical wound infection | during the postoperative one month |
| Surgical wound dehiscence | The rate of surgical wound dehiscence | during the postoperative one month |
| Incidence of acute kidney injury | Incidence of postoperative acute kidney injury | during the postoperative one month |
| Incidence of surgical re-intervention | Incidence of surgical re-open | during the postoperative one month |
| ID | Term |
|---|---|
| D001261 | Pulmonary Atelectasis |
| ID | Term |
|---|---|
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
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