Protective Ventilation With Higher Versus Lower PEEP During General Anesthesia for Surgery in Obese Patients
| Status: | Completed |
|---|---|
| Conditions: | Obesity Weight Loss, Hospital |
| Therapuetic Areas: | Endocrinology, Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 1/5/2019 |
| Start Date: | July 2014 |
| End Date: | May 2018 |
Postoperative respiratory failure, particularly after surgery under general anesthesia, adds
to the morbidity and mortality of surgical patients. Anesthesiologists inconsistently use
positive end-expiratory pressure (PEEP) and recruitment maneuvers in the hope that this may
improve oxygenation and protect against postoperative pulmonary complications (PPCs),
especially in obese patients. While anesthesiologists tend to use PEEP higher than in
non-obese patients. While it is uncertain whether a strategy that uses higher levels of PEEP
with recruitment maneuvers truly prevents PPCs in these patients, use of higher levels of
PEEP with recruitment maneuvers could compromise intra-operative hemodynamics.
The investigators aim to compare a ventilation strategy using higher levels of PEEP with
recruitment maneuvers with one using lower levels of PEEP without recruitment maneuvers in
obese patients at an intermediate-to-high risk for PPCs.
We hypothesize that an intra-operative ventilation strategy using higher levels of PEEP and
recruitment maneuvers, as compared to ventilation with lower levels of PEEP without
recruitment maneuvers, prevents PPCs in obese patients at an intermediate-to-high risk for
PPC.
to the morbidity and mortality of surgical patients. Anesthesiologists inconsistently use
positive end-expiratory pressure (PEEP) and recruitment maneuvers in the hope that this may
improve oxygenation and protect against postoperative pulmonary complications (PPCs),
especially in obese patients. While anesthesiologists tend to use PEEP higher than in
non-obese patients. While it is uncertain whether a strategy that uses higher levels of PEEP
with recruitment maneuvers truly prevents PPCs in these patients, use of higher levels of
PEEP with recruitment maneuvers could compromise intra-operative hemodynamics.
The investigators aim to compare a ventilation strategy using higher levels of PEEP with
recruitment maneuvers with one using lower levels of PEEP without recruitment maneuvers in
obese patients at an intermediate-to-high risk for PPCs.
We hypothesize that an intra-operative ventilation strategy using higher levels of PEEP and
recruitment maneuvers, as compared to ventilation with lower levels of PEEP without
recruitment maneuvers, prevents PPCs in obese patients at an intermediate-to-high risk for
PPC.
Inclusion Criteria:
- Patient scheduled for open or laparoscopic surgery under general anesthesia
- Intermediate-to-high risk for PPCs following surgery, according to the ARISCAT risk
score (≥ 26)
- BMI ≥ 35 kg/m2
- Expected duration of surgery ≥ 2 h
Exclusion Criteria:
- Age < 18 years
- Previous lung surgery (any)
- Persistent hemodynamic instability, intractable shock (considered hemodynamically
unsuitable for the study by the patient's managing physician)
- History of previous severe chronic obstructive pulmonary disease (COPD) (non-invasive
ventilation and/or oxygen therapy at home, repeated systemic corticosteroid therapy
for acute exacerbations of COPD)
- Recent immunosuppressive medication (patients receiving chemotherapy or radiation
therapy up to two months prior to surgery)
- Severe cardiac disease (New York Heart Association class III or IV, acute coronary
syndrome or persistent ventricular tachyarrhythmias)
- Invasive mechanical ventilation longer than 30 minutes (e.g., general anesthesia for
surgery) within last 30 days
- Pregnancy (excluded by anamneses and/or laboratory analysis)
- Prevalent acute respiratory distress syndrome expected to require prolonged
postoperative mechanical ventilation
- Severe pulmonary arterial hypertension, defined as systolic pulmonary artery pressure
> 40 mmHg
- Intracranial injury or tumor
- Neuromuscular disease (any)
- Need for intraoperative prone or lateral decubitus position
- Need for one-lung ventilation
- Cardiac surgery
- Neurosurgery
- Planned reintubation following surgery
- Enrolled in other interventional study or refusal of informed consent
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