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This study investigates if single lung ventilation on cardiopulmonary bypass can mitigate postoperative lung water accumulation determined by lung ultrasound in the ventilated lung as compared to the non-ventilated lung in patients at high-risk for developing severe pulmonary complications after cardiac surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Risk group | Active Comparator | Lung ventilated during cardiopulmonary bypass using single-lung ventilation via double-lumen tube. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ventilated lung | Procedure | This lung will be ventilated during cardiopulmonary bypass using volume-controlled ventilation with a tidal volume of 3 mL/kg ideal body weight, a PEEP of 5 cmH2O, a respiratory rate of 10/min, and a fraction of inspired oxygen of 30%. |
| Measure | Description | Time Frame |
|---|---|---|
| Lung aeration score of both lungs. | The aeration score of each lung is the sum of the aeration scores determined in each of six lung quadrants in each lung, which can range from 0 (normal ventilation) to 3 (atelectasis/consolidation). | Lung ultrasound investigations will be performed at baseline, i.e., before surgery, on the day of surgery, and on day 1 and 2 after surgery in the intensive care unit. |
| Measure | Description | Time Frame |
|---|---|---|
| Radiologic assessment of Kerley B lines as indicators of lung edema. | Number of Kerley B lines in both lungs determined by chest x-ray where stage 1 (no Kerley B lines) reflects best outcome, stage 2 (Kerley B lines become visible) indicates interstitial edema, and stage 3 (increased number of Kerley B lines also in non-dependent areas and partially obscured in dependent parts of the lung) are a sign of alveolar edema. |
| Measure | Description | Time Frame |
|---|---|---|
| Length of ICU and hospital stay. | The duration from transfer to the intensive care unit until discharge to a step-down unit and the duration of hospitalization of the patient will be determined in days. | These variables will be censored at study completion, on average 30 days. |
| In-hospital mortality. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Martin Dworschak, MD, MBA | Contact | +43-1-40400 | 41090 | martin.dworschak@meduniwien.ac.at |
| Edda M. Tschernko, MD, MBA | Contact | +43-1-40400 | 41060 | edda.tschernko@meduniwien.ac.at |
| Name | Affiliation | Role |
|---|---|---|
| Martin Dworschak, MD, MBA | Medical University of Vienna | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| General Hospital Vienna | Vienna | State of Vienna | 1090 | Austria |
The primary reason for not sharing IPD is the protection of patient privacy.
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With single-lung ventilation with a double lime tube during cardiopulmonary bypass each patient will be her own control, i.e., the lung that had been ventilated can be compared with the contralateral lung that had not been ventilated during the bypass run.
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| Non-ventilated lung. | Procedure | The contralateral lung will not be ventilated during cardiopulmonary bypass and will be allowed to collapse. |
|
| Performed on the day of surgery and on day 1 and 2 after surgery on the intensive care unit. |
| Presence of pleural effusion in chest x-ray. | Severity assessment will be semi-quantitative with 0 = no effusion, 1 = small effusion (with blunting of the basal lung segments and the costophrenic angle), 2 = moderate effusion (fluid extents to the mid-hemithorax creating a "meniscus sign"), and 3 = massive effusion (the whole lung appears opaque with displacement of the heart to the contralateral side if located unilaterally). | Performed on the day of surgery and on day 1 and 2 after surgery on the intensive care unit. |
| Determination of the Global Inhomogeneity (GI) index in both lungs separately by thoracic Electrical Impedance Tomography (EIT). | Global inhomogeneity is calculated as the sum of the absolute differences between the median value of tidal variation and every single pixel value, divided by the sum of all impedance values, to normalize the calculated values. A GI index closer to 0 represents highly homogeneous (even) ventilation. Higher values (i.e., > 0.5) indicate that some parts of the lung are over-distended while others are poorly aerated or collapsed (atelectasis). | On the day of surgery and on day 1 and 2 after surgery in the intensive care unit. |
| Worst oxygenation (Horowitz) index measured per day during routine blood gas checks. | The Horowitz index (HI) is calculated by diving arterial oxygen partial pressure determined in the blood gas by the fraction of inspired oxygen. It will be assessed after each blood gas check and the lowest HI during one day will be entered for further statistical analysis. The degree of impaired lung function will be determined as follows: HI > 300 mmHg (healthy lung function), HI between 201-300 mmHg (mild lung injury), HI between 101-200 mmHg (moderately severely impaired lung function), and HI < 100 mmHg (severe lung injury, ARDS). | Assessed on the day of surgery and on day 1 and 2 after surgery. |
| Static lung compliance determined in each lung separately. | Static lung compliance of the ventilated and the non-ventilated lung will be determined twice for each patient. Static compliance in healthy adults ranges between 60 and 100 mL/cm H₂O. Values below 50 mL/cm H₂O would be considered abnormally low. | On the day of surgery in the operating room before and after cardiac surgery on cardiopulmonary bypass when the patient is still ventilated via double lumen tube. |
| Amount of released immune modulators. | Serum levels for HSP70, MMP-8, MMP-9, TIMP-1, and Lipocalin-2 will be determined in patients' blood samples, with normal values ranging from 0.2-3 ng/mL for HSP70, 0.3-1.2 ng/mL for MMP-8, 14-100 ng/mL for MMP-9, 80-150 ng/mL for TIMP-1, and 20-130 ng/mL for Lipocalin-2, respectively. | Determined on the day of surgery as well as on day 1, 2, 3, and 4 after surgery. |
It will be recorded if the patient has been discharged from the hospital alive. |
| In-hospital mortality will be censored at study completion, on average 30 days. |
| Duration on respiratory support via endotracheal tube. | The hours between arrival of the intubated patient on the intensive care unit until extubation will be determined. | The time until extubation will be censored at study completion, on average 30 days. |
| Postoperative complications. | Any complication that poses a risk for the patient occurring during the hospital stay and having been documented in the patient's file will be retrieved by carefully reviewing the files and recorded. | All complications will be censored at study completion, on average 30 days. |