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Ventilated Patients especially those undergoing upper abdominal surgeries are prone to lung atelectasis. They are at risk of adverse effects secondary to inadequate lung ventilation.
Applied PEEP and Recruitment maneuver are thought to enhance lung aeration under general anesthesia which could be assessed by ultrasound.
The aim of our study is to assess the effect of using PEEP with and without recruitment maneuver on atelectasis and lung aeration during open upper abdominal surgeries by ultrasonography.
Application of PEEP improves intraoperative oxygenation and thus could minimize the incidence of postoperative atelectasis and respiratory complications during abdominal surgeries.
A recent study found that PEEP and RM prevented intraoperative aeration loss, which didn't persist after extubation when comparing effects of positive end-expiratory pressure/recruitment maneuvers with zero end-expiratory pressure on atelectasis during open gynecological surgery by ultrasonography
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Low PEEP | Placebo Comparator | Low positive end-expiratory pressure (PEEP) and no recruitment maneuver (RM) |
|
| High PEEP | Active Comparator | High positive end-expiratory pressure (PEEP) |
|
| High PEEP/RM | Active Comparator | High positive end-expiratory pressure (PEEP) and recruitment maneuver (RM) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Low PEEP | Procedure | Patients will be ventilated with a PEEP of 4 cm H2O and no RMs throughout the study |
|
| Measure | Description | Time Frame |
|---|---|---|
| Pre-emergence LUS score | Lung ultrasonography score (LUS score) between groups at the end of surgery (just before emergence) as a lower LUS indicates better lung aeration. | intraoperative before recovery from anesthesia |
| Measure | Description | Time Frame |
|---|---|---|
| Lung ultrasonography score (LUS score) | Lung ultrasonography score (LUS score) between groups | preoperative, intraoperative for anesthesia duration to 1 hour postoperative |
| Heart rate | heart rate between groups at each time point of LUS score performance |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Aboelnour E Badran, MD | Professor of Anesthesia and Surgical Intensive Care | Study Chair |
| Hanaa M EL- Bendary, MD | Assistant Professor of Anesthesia and Surgical Intensive Care | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Mansoura University | Al Mansurah | DK | 050 | Egypt |
will be available after completing the study and acceptance for publication
after completing the study and acceptance for publication
Sharing Criteria: the data will be accessible to the investigators and PRS administrators with hiding the identifiers for the patients.
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Double-blind (Participant, Outcomes Assessor).
| High PEEP | Procedure | PEEP of 10 cm H2O will be applied |
|
| High PEEP/RM | Procedure | PEEP of 10 cm H2O and RM (30 cm H2O for 30 s) immediately after the second lung ultrasonographic examination and repeated every 30 minutes till emergence |
|
| Lung ultrasonogrphy assessment | Device | The thorax will divided into 12 quadrants, each of them will be assigned a score of 0-3 as 0, normal lung sliding with fewer than three single B lines
|
|
| preoperative, intraoperative for anesthesia duration to 1 hour postoperative |
| Mean blood pressure | mean arterial blood pressure between groups at each time point of LUS score performance | preoperative, intraoperative to 1 hour postoperative |
| oxygen saturation | patient oxygen saturation between groups at each time point of LUS score performance | preoperative, intraoperative to 1 hour postoperative |
| End-tidal carbon dioxide tension | end tidal CO2 between groups post induction, post recruitment and before extubation | intraoperative for anesthesia duration |
| Arterial partial pressure of oxygen (PaO2) | arterial blood gases post induction, before extubation and at the PACU | Intraoperative and 15 min postoperative |
| Arterial partial pressure of carbon dioxide (PaCO2) | arterial blood gases post induction, before extubation and at the PACU | Intraoperative and 15 min postoperative |
| PaO2/FiO2 | arterial blood gases post induction, before extubation and at the PACU | Intraoperative and 15 min postoperative |
| Peak inspiratory pressure | peak inspiratory pressure between groups after intubation | intraoperative for anesthesia duration |
| Postoperative pulmonary complications (PPCs) | PPCs include (pneumothorax, pleural effusion, pulmonary collapse, atelectasis, pneumonia, acute respiratory distress syndrome (ARDS), or pulmonary aspiration). | 5 days |