HFHO vs CPAP During Thoracic Surgery
Condition: Hypoxaemia During Surgery; Lung Hyperinflation
MeSH terms: Hypoxia
Study type: Interventional

Summary: 
      A single institutional cross-over study design to compare between high flow humidified oxygen
      (HFHO) device versus conventional CPAP for non-ventilated lung during thoracic surgery.
    

Detailed description: 
      The investigators hypothesize that HFHO may be an alternative tool to supply oxygen to
      non-ventilated lung during one lung ventilation. CPAP can improve oxygenation at a cost of
      lung hyperinflation which is an unwanted condition during thoracic surgery especially the
      video-assisted one.

      Recruiting adult patients who undergo lung surgeries that requires one-lung ventilation.
      Exclusion criteria include the followings:-

        1. Emergency case.

        2. Patients with severe COPD(Chronic Obstructive Pulmonary Diseases).

        3. Patients with moderate baseline hypoxemia (SpO2 < 90% on room air).

        4. Patients with severe hemoptysis.

        5. Patients with upper or lower airway abnormalities.

        6. Patients undergo pulmonary lavage.

        7. Patients with known pulmonary hypertension.

        8. Patients with known pulmonary/tracheobronchial infections.

        9. Patients with suspected difficult airway.

       10. Patients with BMI over 35.

       11. Pregnant patients.

      Following a standard anesthetic practice. All participants will receive an intravenous based
      anesthetic with or without regional blocks. The appropriate sized double lumen endobronchial
      tube will be placed and fiberoptic bronchoscope is used to verify a proper position. Patient
      will also get an arterial line for frequent ABG (Arterial Blood Gases) samplings.

      Computer generated randomization will divide patients into 2 groups. Baseline ABG will be
      drawn. After one lung ventilation commenced for 20 minutes, the 2nd ABG will be drawn, the
      surgeon who was blinded to the intervention will evaluate the quality of lung collapse using
      5-point Likert scale. Then, patients will either receive a CPAP or HFHO (depends on
      randomization) for 20 minutes. Up on 1st intervention completion, the 3rd ABG and lung
      collapse evaluation will be performed.

      Following the first intervention, the non-ventilated lung will be suctioned out and wait for
      20 minutes. Another ABG will be sampled at this point.

      The patient will receive the 2nd alternative intervention (CPAP or HFHO- depend on their
      randomization) for 20 minutes. The final ABG and lung collapse evaluation will be performed.

      If any severe hypoxemia/ hypercarbia and marked violation of protocol occurs. Patients will
      be excluded.
    

Intervention name(s): CPAP; HFHO
Intervention type(s): Device; Device
Intervention description(s): Conventional CPAP; A device that can provide heated humidified oxygen up to 30-60 liter per minute, FiO2 (fraction of inspired oxygen) 0.21-0.95
Other intervention name(s): Mallinkrodt CPAP; Optiflow, Airvo
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: HFHO-CPAP CPAP-HFHO
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: High flow oxygen device, HFHO, CPAP, One-lung ventilation