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Male and female patients Undergoing laparoscopic bariatric surgeries will be subjected for lung recruitment at end of surgery before emergence from anesthesia by two different methods . to evaluate which might be safer and more effective
In the SI group:, the anesthesiologist adjust the ventilator to manual ventilation mode and ad¬just The ventilator will be switched to manual mode, and the airway pressure-limiting valve will be set to 30 cmH₂O. A sustained manual inflation was then applied by gradually squeezing the anesthesia reservoir bag over 3-5 seconds until a peak airway pressure (Ppeak) of 30 cmH₂O was achieved. This pressure was maintained continuously for 30 seconds. Following the maneuver, mechanical ventilation was resumed with positive end-expiratory pressure (PEEP) back to 5 cmho In the IP group:, alveolar recruitment will be performed as follows: ventilation will be set to pressure control mode and the driving pressure maintained at 10 cmH2O with an initial PEEP of 5 cmH2O, respiratory rate 8-10, I:E 1-1PEEP will be then increased by 5 cmH2O ev¬ery 30 s until the Ppeak reached 30 cmH2O (so peep will reach 20), held for 30 s , then PEEP will be gradually reduced at intervals of 5 cmH2O down to 5 cmH2O, when initial volume control ventilation will be resumed. In the incremental PEEP group, PEEP was increased stepwise by 5 cmH₂O every 3-5 breaths until a peak airway pressure of 30 cmH₂O was achieved, after which mechanical ventilation was resumed with maintenance PEEP. The total duration of the recruitment maneuver was approximately 60-90 seconds.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| group SI | Active Comparator | receive 30 cmH₂O sustained inflation for 30seconds |
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| group IP | Active Comparator | receive PEEP was increased stepwise by 5 cmH₂O every 3-5 breaths until a peak airway pressure of 30 cmH₂O |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| sustained inflation recruitement | Procedure | anesthesiologist adjust the ventilator to manual ventilation mode and ad¬just The ventilator was switched to manual mode, and the airway pressure-limiting valve was set to 30 cmH₂O. A sustained manual inflation was then applied by gradually squeezing the anesthesia reservoir bag over 3-5 seconds until a peak airway pressure (Ppeak) of 30 cmH₂O |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative lung aeration | limited-zone lung ultrasound scoring system | in the post-anesthesia care unit 15 minutes after extubation |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative oxygenation | SpO₂ | in the post-anesthesia care unit 15 minutes after extubation |
| Oxygen requirement in PACU | to maintain SpO₂ ≥94%. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| amr fouad, M.D | Contact | 01225674370 | amr_foud@med.asu.edu.eg |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ain Shams university hospitals | Recruiting | Cairo | 11591 | Egypt |
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| Stepwise PEEP | Procedure | : ventilation will be set to pressure control mode and the driving pressure maintained at 10 cmH2O with an initial PEEP of 5 cmH2O, respiratory rate 8-10, I:E 1-1PEEP will be then increased by 5 cmH2O ev¬ery 30 s until the Ppeak reached 30 cmH2O |
|
| in the post-anesthesia care unit 15 minutes after extubation |