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The investigators want to assess the effect of intraoperative low tidal volume vs intermediate tidal volume on respiratory mechanics, oxygenation and pulmonary complications in older patients undergoing Trendelenburg pneumoperitoneum surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| group L | Placebo Comparator | Ventilation was subsequently changed to individualized positive end-expiratory pressure and recruitment maneuvers during trendelenburg pneumoperitoneum, and the tidal volume was set to 6 ml/kg. |
|
| group I | Experimental | Ventilation was subsequently changed to individualized positive end-expiratory pressure and recruitment maneuvers during trendelenburg pneumoperitoneum, and the tidal volume was set to 8 ml/kg. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| group L (Vt 6 ml/kg) | Other | low tidal volume ventilation (tidal volume was set to 6 ml/kg) |
| |
| Measure | Description | Time Frame |
|---|---|---|
| PaO2/FiO2 | the outcome in mmHg | the lowest value at one hour after extubation, day-1 to day-3 |
| hypoxemia | the outcome in fraction | From date of patient admission until the date of discharge, assessed up to 7 days |
| pneumonia | the outcome in fraction | From date of patient admission until the date of discharge, assessed up to 7 days |
| bronchospasm | the outcome in fraction | From date of patient admission until the date of discharge, assessed up to 7 days |
| atelectasis | the outcome in fraction | From date of patient admission until the date of discharge, assessed up to 7 days |
| pulmonary congestion | the outcome in fraction | From date of patient admission until the date of discharge, assessed up to 7 days |
| respiratory failure | the outcome in fraction | From date of patient admission until the date of discharge, assessed up to 7 days |
| pleural effusion | the outcome in fraction | From date of patient admission until the date of discharge, assessed up to 7 days |
| Measure | Description | Time Frame |
|---|---|---|
| Tidal volume | the outcome in milliliter | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3) |
| respiratory rate |
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Inclusion Criteria:
Exclusion Criteria:
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A randomized, double-blind, controlled trial
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| group I (Vt 8 ml/kg) |
| Other |
intermediate tidal volume ventilation (tidal volume was set to 8 ml/kg) |
|
| pneumothorax | the outcome in fraction | From date of patient admission until the date of discharge, assessed up to 7 days |
| unplanned requirement for postoperative invasive or noninvasive ventilation | the outcome in fraction | From date of patient admission until the date of discharge, assessed up to 7 days |
the outcome in times/minute (frequency) |
| before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3) |
| dead space fraction | the outcome in fraction | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3) |
| A-aDO2 | the outcome in mmHg | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3) |
| intrapulmonary shunt | the outcome in fraction | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3) |
| peak airway pressure | the outcome in cmH2O | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3) |
| plateau airway pressure | the outcome in cmH2O | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3) |
| mean airway pressure | the outcome in cmH2O | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3) |
| dynamic compliance | the outcome in milliliter/cmH2O | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3) |
| arterial blood pH | the outcome in number | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3). |
| arterial blood PO2 | the outcome in mmHg | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3). |
| arterial blood PCO2 | the outcome in mmHg | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3). |
| arterial blood Hb | the outcome in g/dl | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3). |
| arterial blood Hct | the outcome in fraction | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3). |
| arterial blood SO2 | the outcome in fraction | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3). |
| arterial blood K | the outcome in mmol/L | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3). |
| arterial blood Na | the outcome in mmol/L | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3). |
| arterial blood Ca | the outcome in mmol/L | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3). |
| arterial blood Cl | the outcome in mmol/L | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3). |
| arterial blood Glu | the outcome in mmol/L | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3). |
| arterial blood Lac | the outcome in mmol/L | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3). |
| arterial blood tBil | the outcome in umol/L | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3). |
| arterial blood SBE | the outcome in mmol/L | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3). |
| arterial blood ABE | the outcome in mmol/L | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3). |
| PaO2/FiO2 | the outcome in mmHg | before anesthesia induction (T1); 60 minutes after initiation of the Trendelenburg position and CO2 pneumoperitoneum (T2), and 10 minutes after desufflation and resuming the supine position (T3). |
| unplanned intensive care unit admission | the outcome in fraction | From date of finishing surgery until the date of patient discharge, assessed up to 7 days |
| intensive care unit length of stay | the outcome in days | From date of finishing surgery until the date of patient discharge, assessed up to 7 days |
| postoperative mortality | the outcome in fraction | From date of finishing surgery until the date of patient discharge, assessed up to 7 days |
| hospital length of stay | the outcome in days | From date of patient admission until the date of discharge, assessed up to 10 days |