Clinical Trial: Evaluation of the Effect of Lung Recruitment and Positive End- Expiratory Pressure (PEEP) on Anesthesia Induced Atelectasis Using Lung Ultrasound

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional

Official Title: Evaluation of the Effect of Lung Recruitment and Positive End- Expiratory Pressure (PEEP) on Anesthesia Induced Atelectasis Using Lung Ultrasound in Children Undergoing Ma

Brief Summary:

Atelectasis is a side effect of general anesthesia which can be found in all types of interventions and patients of all ages.1-3 The reported incidence of anesthesia- induced atelectasis in children varies, ranging from 12 to 42% in sedated and nonintubated patients 5, 6 and from 68 to 100% in children with general anesthesia with tracheal intubation or laryngeal mask.

The aim of this work is to evaluate the effect of lung recruitment on anesthesia induced atelectasis using intraoperative lung ultrasound.

Objectives

  • To determine the effect of recruitment on anesthesia induced atelectasis using lung ultrasound.
  • To Estimate the change of Pao2 with anesthesia induced lung atelectasis.
  • To Estimate the change of Pao2 with lung recruitment.
  • To evaluate the feasibility of use of lung ultrasound as a tool to guide optimum lung recruitment.

Detailed Summary:

This a randomized control trial is designed to include 40 children aged from one to four years presented for major abdominal surgery.

Forty patients meeting the inclusion criteria will be randomly assigned into to two equal groups:

Group C (n= 20): Without recruitment maneuver (control group)

Group REC (n= 20): recruitment group

All children will be premedicated with oral midazolam 0.5mg/kg half hour before procedure and atropine at a dose of 0.01-0.02 mg/kg( IM). Continuous electrocardiogram (ECG) , pulse oximetry, non-invasive arterial blood pressure, and temperature monitoring will be applied and all patients will be induced with inhalational anesthetic using Sevoflurane+ oxygen(O2) with mac 2%. After deepening of the anesthesia, intravenous (I.V.) line will be inserted and fentanyl 2μg/kg, muscle relaxant will be given in the form of atracurium 0.5mg/kg and patients will be intubated by appropriate size of endotracheal tube.

After induction of anesthesia all patients will be ventilated using pressure controlled mode targeting tidal volume 6-8 ml/kg with inspiratory to expiratory ( I: E) ratio 1:1.5, and Fio2 1, baseline arterial blood gas will be withdrawn. Patients will be divided into two groups. Group (REC) recruitment group; in this group, lung recruitment manoeuvre will be performed in patients using continuous positive airway pressure( CPAP) (30) cm H2O for (40) seconds after induction of anesthesia then patient will be converted to pressure controlled mode again with PEEP 5 cm H2O22,23. In next assessment time, if still there are atelectatic areas recruitment will be repeated and patient will be maintained at PEEP 10 cm H2O till the end of surgery. In group (C
Sponsor: Kasr El Aini Hospital

Current Primary Outcome: The lung aeration score 5minutes following induction of general anesthesia [ Time Frame: Lung ultrasound examinations will be performed 5minutes following induction of general anesthesia ]

Atelectasis will be assessed by ultrasound using lung aeration score applied for each region. Lung score is four points (0 = normal lung, 1 = moderate aeration loss, 2 = severe aeration loss, 3 = complete aeration loss and consolidation) so, applying score for 12 regions bilateral will result in maximum score 36 and lowest score 0


Original Primary Outcome: Same as current

Current Secondary Outcome: •The sum of surface area of atelectatic regions [ Time Frame: It will be measured at different time-points immediately before induction of anesthesia, 5, 15 minutes following induction of general anesthesia,5 min before extubation and 5 min after extubation at recovery room to detect and monitor atelectasis ]

The sum of surface area of atelectatic regions and the number of recruitment attempts to recruit atelectatic areas will be recorded


Original Secondary Outcome: Same as current

Information By: Kasr El Aini Hospital

Dates:
Date Received: February 10, 2017
Date Started: March 8, 2017
Date Completion: August 2017
Last Updated: March 10, 2017
Last Verified: March 2017