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The Effect of Different I:E Ratio on Gas Exchange of Patients Undergoing One-lung Ventilation for Lung Surgery

This study has been completed.
Sponsor:
ClinicalTrials.gov Identifier:
NCT01540201
First Posted: February 28, 2012
Last Update Posted: December 25, 2013
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Information provided by (Responsible Party):
Sangmin M. Lee, Samsung Medical Center
  Purpose
Pulmonary gas exchange disturbance is a common anesthetic problem during one-lung ventilation (OLV) for thoracic surgery. The inverse-ratio ventilation (IRV), which prolongs the inspiratory time greater than expiratory time, can be applied for adult respiratory distress syndrome. The effect of IRV is to improve gas-exchange status by increasing mean airway pressure and alveolar recruitment. We tried to evaluate the effect of IRV during OLV with lung protective strategy.

Condition Intervention
Lung Cancer One Lung Ventilation Gas Exchange Inverse-ratio Ventilation Other: Conventional I:E ratio Other: I:E = 1:1 ratio

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Official Title: The Effect of Different I:E Ratio on Gas Exchange of Patients Undergoing One-lung Ventilation for Lung Surgery

Resource links provided by NLM:


Further study details as provided by Sangmin M. Lee, Samsung Medical Center:

Primary Outcome Measures:
  • arterial CO2 partial pressure [ Time Frame: 10 minutes after induction of general anesthesia ]
    arteial CO2 partial pressure

  • arterial CO2 partial pressure [ Time Frame: 30 minutes after start of one-lung ventilation ]
    arteial CO2 partial pressure

  • arterial CO2 partial pressure [ Time Frame: 60 minutes after start of one-lung ventilation ]
    arteial CO2 partial pressure

  • arterial CO2 partial pressure [ Time Frame: 15 min after restart of TLV ]
    arteial CO2 partial pressure

  • arterial CO2 partial pressure [ Time Frame: 1 hour after the end of surgery ]
    arteial CO2 partial pressure


Secondary Outcome Measures:
  • arterial O2 partial pressure [ Time Frame: 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation, 1 hour after the end of surgery ]
    arterial O2 partial pressure

  • Mean airway pressure [ Time Frame: 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation ]
    Mean airway pressure

  • tidal volume (exhaled) [ Time Frame: 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation ]
    tidal volume (exhaled)

  • hemodynamic parameters [ Time Frame: 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation ]
    systolic/ diastolic blood pressure, heart rate, mean blood pressure

  • end-tidal CO2 partial pressure [ Time Frame: 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation ]
    end-tidal CO2 partial pressure

  • respiratory compliance [ Time Frame: 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation ]
    Dynamic compliance, Static compliance

  • Dead space [ Time Frame: 10 min after induction, 30 and 60 min after start of one lung ventilation, 15 min after restart of two-lung ventilation ]
    physiologic dead space / tidal volume (VD/VT)

  • work of breathing [ Time Frame: 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation ]
    work of breathing

  • peak inspiratory pressure [ Time Frame: 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation ]
    peak inspiratory pressure

  • plateau pressure [ Time Frame: 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation ]
    plateau pressure

  • positive end-expiratory pressure [ Time Frame: 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation ]
    positive end-expiratory pressure

  • minute ventilation [ Time Frame: 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation ]
    minute ventilation


Enrollment: 110
Study Start Date: February 2012
Study Completion Date: October 2012
Primary Completion Date: October 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: 1:2 group
conventional I:E ratio group, inspiratory time : expiratory time = 1:1
Other: Conventional I:E ratio
conventional I:E ratio of 1:2 is applied. Ventilator : Datex-Ohmeda Aestiva/5 ® model
Other Names:
  • I:E ratio of 1:2
  • Ventilator : Datex-Ohmeda Aestiva/5 ® model
Experimental: 1:1 group
inspiratory time : expiratory time = 1:1
Other: I:E = 1:1 ratio
I:E ratio of 1:1 is applied Ventilator : Datex-Ohmeda Aestiva/5 ® model
Other Names:
  • I:E ratio of 1:1
  • Ventilator : Datex-Ohmeda Aestiva/5 ® model

Detailed Description:
Pulmonary gas exchange disturbance is a common anesthetic problem during one-lung ventilation (OLV) for thoracic surgery. Continuous positive airway pressure or positive end-expiratory pressure are usually applied to improve this disorder including hypoxia, but these methods are not enough. The inverse-ratio ventilation (IRV), which prolongs the inspiratory time greater than expiratory time, can be applied for adult respiratory distress syndrome. The effect of IRV is to improve gas-exchange status by increasing mean airway pressure and alveolar recruitment. The application of IRV during OLV has not been performed to our knowledge, and there is a possibility of IRV to improve oxygenation during OLV. There is a possibility of increase of auto-PEEP, or air trapping in subjects with chronic obstructive pulmonary disease, but this kind of auto-PEEP can be overcome by external PEEP. Therefore, we tried to evaluate the effect of IRV during OLV with lung protective strategy.
  Eligibility

Information from the National Library of Medicine

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Ages Eligible for Study:   20 Years to 70 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • patients undergoing elective lung lobectomy surgery.
  • the duration of one-lung ventilation is more than one hour.
  • subjects with more than twenty years old.

Exclusion Criteria:

  • subjects with past history of pneumothorax, asthma
  • Age under 20, more than 70 years.
  • Patients with ischemic heart disease, valvular heart disease
  • patients with hemodynamic unstability
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01540201


Locations
Korea, Republic of
Samsung Medical Center
Seoul, Korea, Republic of, 135-710
Sponsors and Collaborators
Samsung Medical Center
Investigators
Principal Investigator: Sangmin M. Lee, MD, PhD Samsung Medical Center
Study Director: Won Ho Kim, MD Samsung Medical Center
  More Information

Responsible Party: Sangmin M. Lee, Professor, Samsung Medical Center
ClinicalTrials.gov Identifier: NCT01540201     History of Changes
Other Study ID Numbers: 2011-12-033-002
First Submitted: February 16, 2012
First Posted: February 28, 2012
Last Update Posted: December 25, 2013
Last Verified: December 2013

Keywords provided by Sangmin M. Lee, Samsung Medical Center:
one lung ventilation
gas exchange
inverse-ratio ventilation