Hypoxemia Clinical Trial
— PROVECSOfficial title:
Open Lung Protective Ventilation During Cardiac Surgery With Cardiopulmonary Bypass : a Randomized Controlled Trial
Verified date | December 2016 |
Source | Assistance Publique Hopitaux De Marseille |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Cardiac surgery with cardiopulmonary bypass (CPB) frequently induces post-operative respiratory dysfunction. The post-operative pulmonary complications (PPCs) significantly increase the peri-operative morbidity and require invasive treatments during longer and more expensive ICU stays. A specific pathophysiology involving general anesthesia and CPB-related factors (inflammation, pulmonary ischemia) has been clearly demonstrated and pulmonary atelectasis seems to play a central role in the occurence of these PPCs. The open lung approach is a ventilation strategy that aims to "open the lung and keep it open" using different ventilatory settings. The efficacy of that strategy is not demonstrated in the global surgical population. However, its application in the perioperative care of cardiac surgery patients could be of great interest by counteracting the development of atelectasis. The purpose of this multicentre, double blinded, randomized controlled study is to evaluate the influence of a perioperative multimodal protective ventilation strategy based on the "open lung approach" on postoperative outcomes during the first 7 days following cardiac surgery. Participating centres will include 500 adult patients undergoing scheduled on-pump cardiac surgery. The open lung approach will combine recruitment maneuvers (RM), positive end expiratory pressure (PEEP) at 8 cmH2O from intubation to detubation and continuation of ultraprotective ventilation during CPB. It will be compared to a conventional approach without RM, with PEEP at 2 cmH2O and discontinuation of ventilation during CPB. The primary endpoint is any post-operative pulmonary complication. The secondary endpoints are any post-operative extra-pulmonary complications and the number of ICU-free days to day 7.
Status | Completed |
Enrollment | 494 |
Est. completion date | May 7, 2018 |
Est. primary completion date | May 7, 2018 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Cardiac surgery planned with CPB and sternotomy. - Age > 18 years old. Exclusion Criteria: - Urgent surgery : cardiac transplantation, aortic dissection, active endocarditis. - Aortic arch surgery with circulatory arrest. - LVAD surgery. - Acute or chronic preoperative hypoxemia (PaO2 < 65 mmHg in air). - Preoperative shock state requiring catecholamines. - LVEF < 40%. - Pulmonary hypertension with systolic pulmonary artery pressure > 50 mmHg. - Severe right ventricular dysfunction (TDI tricuspid annular systolic velocity < 10 cm.s-1). - Chronic kidney disease (Glomerular filtration rate < 30 mL/min). - Body Mass Index > 35kg/m2. - Patient's refusal. |
Country | Name | City | State |
---|---|---|---|
France | CHU de Bordeaux | Bordeaux | |
France | Hôpital Louis Pradel HCL | Lyon | |
France | Assistance Publique Hopitaux de Marseille | Marseille | |
France | CHU MontpellierHôpital Arnaud de VILLENEUVE | Montpellier | |
France | Hôpital Européen Georges Pompidou AP-HP | Paris | |
France | CHU Strasbourg | Strasbourg |
Lead Sponsor | Collaborator |
---|---|
Assistance Publique Hopitaux De Marseille |
France,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Post-operative pulmonary complications defined as a composite endpoint | Mild hypoxemia Moderate hypoxemia Severe hypoxemia Severe bronchospam Radiological atelectasis Respiratory acidosis Pneumonia Pleural effusion Acute Respiratory Distress Syndrome Need for reintubation Need for reintubation | first 7 days post-operatively. | |
Secondary | Postoperative extrapulmonary complication | Systemic inflammatory response syndrome Sepsis Septic chock Mediastinitis Pericardial tamponade Surgical bleeding Acute kidney failure (KDIGO stage 2 or 3) Postoperative atrial fibrillation Cardiogenic chock Delirium | First 7 days post operatively | |
Secondary | ICU free Days | Days alive and free from the need of intensive care | First 7 days post operatively |
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