Ultrasonographic Assessment of the Effect of CPB Acute Lung Injury

Study Overview
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Brief Summary
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The study is designed to use the lung ultrasound to assess the effect of intermittent lung recruitment during cardiopulmonary bypass in cardiac surgeries on extra vascular lung water.

Detailed Description
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Significant respiratory dysfunction is a common problem after cardiac surgery, with an incidence of about 25%. the formation of atelectasis appears to be the primary factor responsible for increased intrapulmonary shunt after cardiac surgery with CPB. The investigators will use the lung ultrasound to evaluate the effects of intermittent recruitment of the lungs during CPB on extra vascular lung water (EVLW). Objectives : To evaluate the effect of intermittent lung recruitment during CPB in cardiac surgery on: Lung ultrasound score (LUS),Oxygenation at different times postoperatively,Time for extubation and length of ICU stay sixty patients aged from 18-60 years old, scheduled for elective cardiac surgery with CPB will be included in the study. Patients will be randomly allocated into one of two groups: Group A (n=30): will receive intermittent lung recruitment during CPB.Group B (n=30): control group.

Official Title
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Bedside Lung Ultrasound to Assess Lung Recruiting Maneuver With Cardiopulmonary Bypass in Valvular Cardiac Surgery.

Conditions
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Lung Ultrasound

Intervention / Treatment
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* Procedure: lung recruitment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients aged (18-60 years), elective valvular cardiac surgery with cardiopulmonary bypass (CPB). Exclusion Criteria: • Emergency surgeries. coronary artery bypass graft surgery patients requiring re-exploration in the immediate postoperative period (within 2hours) left Ventricular ejection fraction less than 40% patients with preoperative congestive heart failure, cardiogenic shock , preoperative pulmonary edema pre-existing severe chronic pulmonary dysfunction (defined as pulmonary disease requiring home oxygen therapy or causing shortness of breath after 1 to 2 flights of stairs) Morbid obesity Renally impaired patients with creatinine more than 2 mg/dl

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: sixty patients aged from 18-60 years old, scheduled for elective cardiac surgery with CPB will be included in the study. Patients will be randomly allocated into one of two groups: Group A (n=30): will receive intermittent lung recruitment during CPB.Group B (n=30): control group.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: recruitment group<br>will receive intermittent lung recruitment during CPB | Procedure: lung recruitment<br>* During bypass, patients in this group will receive a lung protective design in the form of continuous positive airway pressure (CPAP) by closing APL valve at pressure of 5 Cm H2o combined with intermittent recruitment by sustained manual lung inflation at a pressure of 35 cmH2O for 30 seconds every (30-40) minute<br>|
| No Intervention: control group<br>will recieve no intervention | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| lung ultrasound score | • The change of lung ultrasound score (a score ranging fom 0/36 to 36/36 where 0/36 is best while 36/36 is worst) from the baseline values for assessment of extra vascular lung water after CBP | Baseline,immediately at the end of operation. 2 hours after ICU admission | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| • The value of Doppler derived E/E' ratio. |  | Baseline,immediately at the end of operation. 2 hours after ICU admission | 
| • Oxygenation (po2),& (po2/fio2) | po2 is measured by mmhg units while PO2/fio2 is ratio | Baseline,immediately at the end of operation. 2 hours after ICU admission | 
| • Time for extubation |  | before extubation | 
| Length of ICU stay |  | before discharge to ward up to 1 week |