Gastroplasty and Electrical Impedance Tomography
Condition: Gastropathy
MeSH terms: Stomach Diseases
Study type: Interventional

Summary: 
      Worldwide there is a high prevalence of morbid obesity with a progressive increase in
      incidence in recent years, causing serious consequences for the health services.
      Approximately 12% of the world population is obese and Brazil is in 77º without world ranking
      of countries in cases of obesity. In this context, bariatric surgery appears as an effective
      method of treating refractory obesity. Support of high fractions of oxygen administered
      during anesthesia is produced, it accepts the use of Positive Positive Positive Pressure
      (PEEP) through the Alveolar Recruitment Maneuver (ARM), which has been used allowing small
      fractions inspired by oxygen, which reduces intra-and postoperative atelectasis and optimizes
      gas exchange during anesthesia. In order to better monitor ventilatory mechanics, Electrical
      Impedance Tomography (EIT) appears as a cheap imaging method when compared to a non-invasive
      magnetic resonance imaging (CT) or MRI, with no side effects and recent studies shown in its
      life as pneumothorax , MRA monitoring, collapse detection, and PEEP titration. The aim of
      this study is to evaluate the impact of ARM and its repercussions on lung function and
      respiratory mechanics. This is a randomized controlled clinical trial with patients
      undergoing videolaparoscopic gastroplasty surgery, of both sexes. Patients were randomly
      assigned to Control Group and Experimental Group. Patient evaluation is performed without
      before, during and postoperative, through a pulmonary function test and EIT.
    


Intervention name(s): Alveolar Recruitment Maneuver; Conventional mechanical ventilation
Intervention type(s): Procedure; Procedure
Intervention description(s): Patients in the Experimental Group will be submitted to ARM, immediately after abdominal desinflation of the pneumoperitoneum (PNP). The ARM will be performed with PEEP of 15 cmH2O for thirty seconds, 20 cmH2O for thirty seconds, 25 cmH2O for thirty seconds, 30 cmH2O for one minute and a inspiratory plateau pressure of 15 cmH2O above PEEP, totaling two minutes and thirty seconds.The data of the TIE will be continuously recorded and the hemodynamic and respiratory function variables such as heart rate (HR), respiratory rate (RF), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2) and final gas expiratory pressure carbon dioxide (PETCO2) will be recorded in several moments: immediately after the monitoring, and the patient is still on spontaneous ventilation, 5min after orotracheal intubation, after the installation of the pneumoperitoneum, before and after the execution of the MRA and in the Post-OP, in the first 24h, along with new lung function tests.; Immediately after intubation, patients will undergo mechanical ventilation with the ventilator (Dixtal DX 5020) in volume controlled mode with an ideal tidal volume of 7 ml / kg body weight, a set frequency to maintain a carbon dioxide of 35-42 mmHg, and an inspiratory / expiratory ratio of 1: 2. The inspiratory oxygen fraction (FIO2) will be 0.5.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment