Respiratory and Hemodynamics Parameters Response to Positive End-Expiratory Pressure
Condition: Obesity Associated Disorder
Study type: Interventional

Summary: 
      In this study, the sixty mechanically ventilated class I obese patients were divided into two
      equal groups A and B. group A received RTP position + PEEP protocol, while group B underwent
      RTP position protocol only. The results showed that the group A protocol has positive effects
      on the improvement of respiratory mechanics by significant increase the arterial oxygen
      partial pressure (PaO2) in mmHg to fractional inspired oxygen (FiO2), (PaO2/FiO2 ratio),
      partial pressure of carbon dioxide (PaCO2), and static compliance (Cstat) parameters.
      Moreover, a significant decrease in hemodynamics of BP& MAP was measured. While the results
      of the group B protocol demonstrated a non-significant increase in the PaO2/FiO2 ratio,
      PaCO2, and Cstat. Besides, non-significant decreases in hemodynamics of blood pressure (BP) &
      mean arterial blood pressure (MAP) were recorded.
    

Detailed description: 
      Objective To investigate the effect of the positive end-expiratory pressure (PEEP) titration
      maneuver with Reverse Trendelenburg Position (RTP) on the respiratory and hemodynamic
      parameters of mechanically ventilated obese patients.

      Design Randomized, control trial. Participants Thirty mechanically ventilated obese patients
      were randomized equally as a group A to receive Reverse Trendelenburg Position (RTP) +
      Positive End Expiratory Pressure (PEEP) titration, and group (B): receive Reverse
      Trendelenburg Position (RTP).

      Intervention After post-operative bariatric surgeries, the sixty mechanically ventilated
      obese patients immediately receive a PEEP and RTP once before the weaning through the
      ventilator of the operation to evaluate the response of arterial blood gases before admission
      to the intensive care unit ICU room.

      Outcomes The primary outcomes included the respiratory parameters (PaO2/FiO2 ratio, PaCO2,
      Cstat), and the secondary outcomes included the hemodynamics parameters (systolic blood
      pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP)).
    

Intervention name(s): respiratory parameters on mechanical ventilator (PEEP)
Intervention type(s): Device
Intervention description(s): The 3rd & 4th phases of operation in the group (A) and (B): Each patient received one single session inside the Operation Room (OR) as one shot of the treatment procedure. Arterial Blood Gases (ABGs) were obtained to measure:
Oxygenation by PaO2/FiO2 ratio with constant FiO2 = 100% (oxygen) through the procedure time as a primary outcome.
Secondary outcome.
Ventilation by PaCO2 value from ABGs.
Static compliance (Cstat) was measured as the amount of recruitment of alveoli in the lung.
Blood pressure (systolic/diastolic) one of the hemodynamics measurements was measured pre/post the procedure in the two groups.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: group A receive Reverse Trendelenburg Position (RTP) + Positive End Expiratory Pressure (PEEP) titration, and group (B): receive Reverse Trendelenburg Position (RTP).
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Positive end-expiratory pressure titration; Mechanical ventilator; respiratory and hemodynamics parameters; Obese patients; Reverse Trendelenburg Position.