Elderly Clinical Trial
Official title:
Effect of Individualized PEEP Titration on Postoperative Pulmonary Complications in Elderly Patients Undergoing Laparoscopic Surgery- A Multicenter Randomized Controlled Clinical Trial
This study aims to investigate the effectiveness and safety of implementing a personalized positive end-expiratory pressure (PEEP) management strategy guided by esophageal pressure (Pes), as well as its potential to reduce the occurrence of postoperative pulmonary complications (PPCs) in elderly patients undergoing laparoscopic surgery.
Status | Recruiting |
Enrollment | 232 |
Est. completion date | August 2025 |
Est. primary completion date | November 2024 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 65 Years and older |
Eligibility | Inclusion Criteria: 1. Patients aged 65 years or older, of any gender. 2. Laparoscopic surgery under general anesthesia. 3. Anticipated duration of surgery = 2 hours. 4. Willingness to sign informed consent or provide a legally authorized representative. Exclusion Criteria: 1. Obesity, defined as BMI = 35 kg/m2. 2. History of pulmonary surgery (of any type). 3. History of severe chronic obstructive pulmonary disease (COPD) requiring non-invasive ventilation and/or home oxygen therapy, or systemic corticosteroid treatment for acute COPD exacerbations. 4. Severe pulmonary arterial hypertension, defined as pulmonary artery systolic pressure > 40 mmHg. 5. Heart failure, ongoing hemodynamic instability, or severe shock (as determined by the attending internist), cardiac index < 2.5 L/min/m2, or the requirement for positive inotropic drugs to maintain blood pressure. 6. Severe cardiac disease (NYHA class III or IV, acute coronary syndrome, sustained ventricular tachyarrhythmias, unable to achieve > 4 METs). 7. Severe liver or renal dysfunction (Child-Pugh score 10-15, serum creatinine = 2 mg/dL, or patients requiring peritoneal dialysis or hemodialysis). 8. Neuromuscular disease (of any type). 9. History of bone marrow transplantation or recent use of immunosuppressive drugs (chemotherapy or radiotherapy within 2 months before surgery). 10. Mechanical ventilation duration > 30 minutes within the past 30 days (e.g., during surgery under general anesthesia). 11. Requirement for one-lung ventilation. 12. History of acute respiratory distress syndrome with potential need for prolonged postoperative mechanical ventilation. 13. Planned re-intubation after surgery. 14. Pregnancy (excluded by medical history and/or laboratory tests). 15. Brain injury or tumor. 16. Requirement for prone or lateral position during surgery. 17. Severe esophagogastric varices. 18. Enrollment in other interventional studies or refusal to sign informed consent. |
Country | Name | City | State |
---|---|---|---|
China | 180 Fenglin Road | Shanghai | |
China | Fudan University Shanghai Cancer Center | Shanghai | |
China | Shanghai Geriatric Medical Center | Shanghai | |
China | Zhongshan Hospital (Xiamen), Fudan University | Xiamen | |
Switzerland | University Hospital, Basel, Switzerland | Basel |
Lead Sponsor | Collaborator |
---|---|
Shanghai Zhongshan Hospital | Fudan University, Shanghai Geriatric Medical Center, University Hospital, Basel, Switzerland, Zhongshan Hospital (Xiamen), Fudan University |
China, Switzerland,
Akoumianaki E, Maggiore SM, Valenza F, Bellani G, Jubran A, Loring SH, Pelosi P, Talmor D, Grasso S, Chiumello D, Guerin C, Patroniti N, Ranieri VM, Gattinoni L, Nava S, Terragni PP, Pesenti A, Tobin M, Mancebo J, Brochard L; PLUG Working Group (Acute Respiratory Failure Section of the European Society of Intensive Care Medicine). The application of esophageal pressure measurement in patients with respiratory failure. Am J Respir Crit Care Med. 2014 Mar 1;189(5):520-31. doi: 10.1164/rccm.201312-2193CI. — View Citation
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Fernandez-Bustamante A, Sprung J, Parker RA, Bartels K, Weingarten TN, Kosour C, Thompson BT, Vidal Melo MF. Individualized PEEP to optimise respiratory mechanics during abdominal surgery: a pilot randomised controlled trial. Br J Anaesth. 2020 Sep;125(3):383-392. doi: 10.1016/j.bja.2020.06.030. Epub 2020 Jul 16. — View Citation
Ferrando C, Soro M, Unzueta C, Suarez-Sipmann F, Canet J, Librero J, Pozo N, Peiro S, Llombart A, Leon I, India I, Aldecoa C, Diaz-Cambronero O, Pestana D, Redondo FJ, Garutti I, Balust J, Garcia JI, Ibanez M, Granell M, Rodriguez A, Gallego L, de la Matta M, Gonzalez R, Brunelli A, Garcia J, Rovira L, Barrios F, Torres V, Hernandez S, Gracia E, Gine M, Garcia M, Garcia N, Miguel L, Sanchez S, Pineiro P, Pujol R, Garcia-Del-Valle S, Valdivia J, Hernandez MJ, Padron O, Colas A, Puig J, Azparren G, Tusman G, Villar J, Belda J; Individualized PeRioperative Open-lung VEntilation (iPROVE) Network. Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial. Lancet Respir Med. 2018 Mar;6(3):193-203. doi: 10.1016/S2213-2600(18)30024-9. Epub 2018 Jan 19. — View Citation
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Zhang C, Xu F, Li W, Tong X, Xia R, Wang W, Du J, Shi X. Driving Pressure-Guided Individualized Positive End-Expiratory Pressure in Abdominal Surgery: A Randomized Controlled Trial. Anesth Analg. 2021 Nov 1;133(5):1197-1205. doi: 10.1213/ANE.0000000000005575. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | postoperative pulmonary complications | the incidence of postoperative pulmonary complications | day 1 to day 7 after surgery, and day 30 after surgery | |
Secondary | airway peak pressure (cmH2O) | intraoperative mechanical ventilation parameters | intraoperative | |
Secondary | driving pressure (cmH2O) | intraoperative mechanical ventilation parameters | intraoperative | |
Secondary | Vt (ml) | tidal volume | intraoperative | |
Secondary | dynamic lung compliance (mL/cmH20) | Cdyn = Vt/(Ppeak - PEEP) | intraoperative | |
Secondary | PaCO2 (mmHg) | measured the partial pressure of carbon dioxide in arterial blood | intraoperative | |
Secondary | EtCO2 (mmHg) | End-tidal carbon dioxide | intraoperative | |
Secondary | PaO2/FiO2 ratio | the ratio of partial pressure of oxygen in arterial blood (PaO2) to the fraction of inspiratory oxygen concentration (FiO2) | intraoperative | |
Secondary | PaO2 (mmHg) | partial pressure of oxygen in arterial blood | intraoperative | |
Secondary | non-respiratory complications | the incidence of stroke, myocardial infarction, acute renal failure, DIC, SIRS, sepsis, septic shock, wound infection | day 1 to day 7 after surgery, and day 30 after surgery | |
Secondary | QoR-15 scores | early quality of recovery | day 1 and day 3 after surgery, the day of discharge, and day 30 after surgery | |
Secondary | unplanned reintubation | the incidence of unplanned reintubation | day 1 to day 7 after surgery | |
Secondary | unplanned transfer to the ICU | the incidence of unplanned transfer to the ICU | day 1 to day 7 after surgery | |
Secondary | duration of ICU stay | duration of ICU stay | day 1 after surgery to the day of discharge, assessed up to 90 days | |
Secondary | length of hospital stay | the number of days from a patient's hospital admission to discharge | from the day of admission to the day of discharge, assessed up to 90 days | |
Secondary | mortality rates | mortality rates | at 30 and 90 days |
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