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The effect of individualized titration of positive end expiratory pressure guided by electrical impedance tomography on ventilation distribution during laparoscopic radical resection of colorectal cancer in the elderly

ABSTRACT: Interventions: A group:Intervention: The PEEP incremental method for lung recruitment starts with PEEP 5 cmH2O, increasing PEEP 5 cmH2O every 5 breaths until PEEP reaches 20cmH2O and maintaining breathing 10 times. Then decrease PEEP to 5 cmH2O by the reversed operation. After lung recruitment, PEEP titration was performed. PEEP gradually decreased from 20 cmH2O to 4 cmH2O, and decreased by 2 cmH2O every 5 breaths. The PEEP value corresponding to the lowest driving pressure was the optimal PEEP value. The method of lung recruitment is the same as before every 1 hour in the future.;Bgroup:Intervention: The PEEP incremental method of lung recruitment starts with PEEP 5 cmH2O and increases PEEP 5cmH2O every 5 breaths until PEEP reaches 20 cmH2O and maintains breathing for 10 times. Then reverse the operation to decrease PEEP to 5 cmH2O. After lung recruitment, PEEP titration was performed. PEEP gradually decreased from 20 cmH2O to 4 cmH2O, and decreased by 2cmH2O every 5 breaths. The PEEP value corresponding to the lowest driving pressure was the optimal PEEP value. No lung recruitment in the future.;C group:Constant 5cmH2O PEEP Primary outcome(s): global impedance curve amplitude Study Design: Parallel

DISEASE(S): Radical Colorectal Surgery

PROVIDER: 113337 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Introduction: The ideal ventilation strategy for patients with massive brain damage requires better elucidation. We hypothesized that in the presence of massive brain injury, a ventilation strategy using low (6 mL/kg) tidal volume (VT) ventilation with open lung positive end-expiratory pressure set according to the minimal static elastance of the respiratory system (LVT/OLPEEP), attenuate the impact of massive brain damage on gas-exchange, respiratory mechanics, lung histology and whole genome alterations compared with high (12 mL/kg) VT and low PEEP ventilation (HVT/LPEEP). Methods: Twenty-eight adult male Wistar rats were randomly assigned to one of four groups: 1) no brain damage (NBD) with LVT/OLPEEP; 2) NBD with HVT/LPEEP; 3) brain damage (BD) with LVT/OLPEEP; and 4) BD with HVT/LPEEP. All animals were mechanically ventilated for six hours. Brain damage was induced by an inflated balloon catheter into the epidural space. Hemodynamics was recorded and blood gas analysis was performed hourly. At the end of the experiment, respiratory system mechanics and lung histology were analysed. Whole genome analysis was performed using Affimetrix gene chips and confirmatory real-time PCR. Results: In NBD, both LVT/OLPEEP and HVT/LPEEP did not affect arterial blood gases, as well as whole genome expression changes and real-time PCR. In BD, LVT/OLPEEP, compared to HVT/LPEEP, reduced lung damage according to histology, genome analysis and real-time PCR with decreased interleukin (IL-6), cytokine-induced neutrophil chemoattractant (CINC)-1 and angiopoietin-4 expressions. LVT/OLPEEP compared to HVT/LPEEP improved overall survival. Conclusions: In BD, LVT/OLPEEP minimizes lung morpho-functional changes and inflammation compared to HVT/LPEEP. LVT/OLPEEP might represent a suitable ventilatory strategy in massive brain damage. 24 Wistar rats - lung samples, 4 groups, 1. non-braindamaged/braindead high tidal volume ventilation, 2. non-braindamaged/braindead best PEEP ventilation, 3. Braindamaged/braindead high tidal volume ventilation, 4. Braindamaged/braindead best PEEP ventilation

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The effect of individualized titration of positive end expiratory pressure guided by electrical impedance tomography on ventilation distribution during laparoscopic radical resection of colorectal cancer in the elderly

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