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the aim of this prospective randomized blinded clinical study will be to assess the ultrasound evaluation of different preventive measures of post operative lung atelectasis in abdominal surgeries; these measures include ventilation and fluid measures
ultrasound evaluation for application of different preventive measures of post operative lung atelectasis, including positive end-expiratory pressure, lung recruitment maneuvers, and restrictive fluid management.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group I: PEEP | Experimental | Patients will be ventilated with PEEP of 8 cm H2O and fluid management: 500 ml of Ringer's lactate in the recovery room before surgery and Ringer's lactate at a rate of 4 mL/kg/hour from the beginning to the end of the surgery. |
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| Group II: PEEP/RM | Experimental | Patients will be ventilated with PEEP of 8 cm H2O, and then RM (30 cm H2O for 30 s) will be applied immediately after the second LUS examination and repeated every 30 minutes till emergence and fluid management: 500 ml of Ringer's lactate in recovery room before surgery and Ringer's lactate at a rate of 4 mL/kg/hour from the beginning to the end of the surgery |
|
| Group III: PEEP/RM/RF | Experimental | Patients will be ventilated with PEEP of 8 cm H2O, and then RM (30 cm H2O for 30 s) will be applied immediately after the second LUS examination and repeated every 30 minutes till emergence and restrictive fluid management (RF). Ringer's lactate at a rate of 3 mL/kg/hour from the beginning to the end of the surgery |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PEEP | Other | Patients will be ventilated with PEEP of 8 cm H2O and fluid management: 500 ml of Ringer's lactate in the recovery room before surgery and Ringer's lactate at a rate of 4 mL/kg/hour from the beginning to the end of the surgery. |
| Measure | Description | Time Frame |
|---|---|---|
| Lung ultrasound assessment of postoperative pulmonary atelectasis at the end of surgery | Lung ultrasound assessment of postoperative pulmonary atelectasis at the end of surgery. The Lung Ultrasound Score (LUS): the key points based on ultrasound findings: I. 0 points: (N) Normal aeration (presence of lung sliding with A-lines or <2 separate B-lines). II. 1 point: (B1) Moderate loss of lung aeration (≥3 well-defined B lines). III. 2 points: (B2) Severe loss of lung aeration (coalescing B-lines). IV. 3 points: (C) Complete loss of lung aeration (pulmonary consolidations). Total Score: points will be distributed according to the worst ultrasound pattern observed: N = 0, B1 lines = 1, B2 lines = 2, C = 3. The LUS score ranging between 0 and 36 was calculated as the sum of points. | at the end of surgery before emergence from GA. |
| Measure | Description | Time Frame |
|---|---|---|
| Lung ultrasound assessment | Lung ultrasound assessment of atelectasis | before induction of general anesthesia |
| Lung ultrasound assessment | Lung ultrasound assessment of atelectasis |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Hamed M Wally Allah | Al-Azhar University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Al-Azhar university | Asyut | Egypt |
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| ID | Term |
|---|---|
| D001261 | Pulmonary Atelectasis |
| ID | Term |
|---|---|
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
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The patients will be assigned into three equal groups of 20 patients each:
A total sample size of 60 patients will be involved.
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| PEEP/RM | Other | Patients will be ventilated with PEEP of 8 cm H2O, and then RM (30 cm H2O for 30 s) will be applied immediately after the second LUS examination and repeated every 30 minutes till emergence and fluid management: 500 ml of Ringer's lactate in recovery room before surgery and Ringer's lactate at a rate of 4 mL/kg/hour from the beginning to the end of the surgery |
|
| PEEP/RM/RF | Other | Patients will be ventilated with PEEP of 8 cm H2O, and then RM (30 cm H2O for 30 s) will be applied immediately after the second LUS examination and repeated every 30 minutes till emergence and restrictive fluid management (RF). Ringer's lactate at a rate of 3 mL/kg/hour from the beginning to the end of the surgery |
|
| 5 minutes post induction of general anesthesia |
| Lung ultrasound assessment | Lung ultrasound assessment of atelectasis | 15 minutes after patients arrive to PACU |
| Lung ultrasound assessment | Lung ultrasound assessment of atelectasis | 60 minutes after patients arrive to PACU |
| arterial blood gases | Pao2, spo2, paco2, pao2/fio2 | 5 minutes post induction of general anesthesia |
| arterial blood gases | Pao2, spo2, paco2, pao2/fio2 | before emergence from general anesthesia |
| arterial blood gases | Pao2, spo2, paco2, pao2/fio2 | 15 minutes after patients arrive to PACU |