Cardiopulmonary Changes Prolonged Surgical Abdominal Retractors Application in Supine Versus Lateral Position
Condition: Cardio-pulmonary
Study type: Observational

Summary: 
      Introduction: Dynamic and static compliance should be calculated as a routine part of
      ventilator monitoring. Dynamic and static compliance are 60-100 mL/cm H2O. A decrease in
      dynamic compliance without a change in the static compliance suggests an acute increase in
      airway resistance and can be assessed further by comparing peak pressure and plateau
      pressure. The normal gradient is approximately 10 cm H2O. A gradient >10 cm H2O may be
      secondary to endotracheal tube obstruction, mucous plugging, or bronchospasm. If volume is
      constant, acute changes in both dynamic and static compliance suggest a decrease in
      respiratory system compliance that may be caused by worsening increasing abdominal pressures.
      When static compliance is <25 mL/cm H2O, ventilator weaning may be difficult secondary to
      tachypnea during spontaneous breathing trials. (1) Aim of the work: to detect the
      cardiopulmonary burden of surgical ring retractors application during abdominal surgeries in
      supine versus lateral position (cancer bladder for supine position and open surgical
      nephrectomy for lateral position). Hypothesis: Abdominal retractors application would produce
      more cardiopulmonary instability during lateral position than during supine position for
      abdominal surgery. Patient & Methods: This comparative prospective randomized study, will be
      done on ASA I-II patients, both sexes, Age 18 - 65 year, to compare pulmonary compliance and
      cardiac performance before, during and after surgical self-retaining abdominal retractors
      application patients will be divided into 2 groups; 1st group (S) will undergo orthotropic
      cancer bladder diversion and the 2nd group (L) both supine and lateral position for open
      surgical nephrectomy for lateral position.
    

Detailed description: 
      Introduction: Dynamic and static compliance should be calculated as a routine part of
      ventilator monitoring. Dynamic and static compliance are 60-100 mL/cm H2O. A decrease in
      dynamic compliance without a change in the static compliance suggests an acute increase in
      airway resistance and can be assessed further by comparing peak pressure and plateau
      pressure. The normal gradient is approximately 10 cm H2O. A gradient >10 cm H2O may be
      secondary to endotracheal tube obstruction, mucous plugging, or bronchospasm. If volume is
      constant, acute changes in both dynamic and static compliance suggest a decrease in
      respiratory system compliance that may be caused by worsening increasing abdominal pressures.
      When static compliance is <25 mL/cm H2O, ventilator weaning may be difficult secondary to
      tachypnea during spontaneous breathing trials. (1) Aim of the work: to detect the
      cardiopulmonary burden of surgical ring retractors application during abdominal surgeries in
      supine versus lateral position (cancer bladder for supine position and open surgical
      nephrectomy for lateral position). Hypothesis: Abdominal retractors application would produce
      more cardiopulmonary instability during lateral position than during supine position for
      abdominal surgery. Patient & Methods: This comparative prospective randomized study, will be
      done on ASA I-II patients, both sexes, Age 18 - 65 year, to compare pulmonary compliance and
      cardiac performance before, during and after surgical self-retaining abdominal retractors
      application patients will be divided into 2 groups; 1st group (S) will undergo orthotropic
      cancer bladder diversion and the 2nd group (L) both supine and lateral position for open
      surgical nephrectomy for lateral position. Study will be done at Mansoura University
      Hospital, during the year 2018, for 4 month duration, starting predected date=1-11-2018
      actual study start date=15-12-2018[ NB. by mistake in the 1st registration i have regestered
      the study protocol predicted time of study start but actually the study started on 15-12-2018
      thats why i changed the date more than one time ] till 30-3-2019 after approval of IRB
      (Institutional Review Board), Mansoura Faculty of Medicine. Primary outcome; composite 1ry
      outcome [1-Dynamic pulmonary compliance.2- Cardiac Index] during and after surgical retractor
      application compared to the same variables reading prior retractor application and in between
      both groups. Secondary outcome: Static lung compliance, Cardiac output, Stroke volume SV -
      stroke volume variability (SVV)-Cardiac performance index CPI, O2 delivery DIO2. Noninvasive
      Intraoperative hemodynamic (MBP, HR, O2 saturation)] during and after surgical ring retractor
      application compared to the same variable reading prior retractor application and in between
      both groups.
    

Intervention name(s): monitoring
Intervention type(s): Other
Intervention description(s): Primary outcome; composite 1ry outcome [1-Dynamic pulmonary compliance monitoring.2- Cardiac Index monitoring] during and after surgical retractor application compared to the same variables reading prior retractor application and in between both groups. Secondary outcome: Static lung compliance, Cardiac output, Stroke volume SV - stroke volume variability (SVV)-Cardiac performance index, O2 delivery DIO2. Noninvasive Intraoperative hemodynamic (MBP, HR, O2 saturation)] during and after surgical ring retractor application compared to the same variable reading prior retractor application and in between both groups.
Observational model: Other
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        -Patients admitted to the Urology Department, Mansoura Urology and Nephrology center,
        Faculty of medicine Mansoura University .
      
Keywords: cardiac, output, pulmonary, compliance, bladder, Retractor.