Evaluation of Protective Pulmonary Ventilation by Pulmonary Ultrasound

Study Overview
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Brief Summary
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Peri - operative ultrasonography was used to evaluate the effects of protective lung ventilation on the postoperative lungs of obese patients.The purpose of this study was to apply ultrasound lung ventilation area score to the monitoring of pulmonary complications in patients with postoperative obesity.To verify the reliability and practicability of perioperative lung ultrasound quantitative scoring.

Detailed Description
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Ultrasound lung ventilation area score was applied to monitor the pulmonary complications of patients after obesity operation to verify the perioperative period. The reliability and practicability of quantitative lung ultrasound score to clarify the effect of protective lung ventilation under perioperative pulmonary ultrasound monitoring on obesity patients.To guide the management of mechanical ventilation under general anesthesia and the prevention and treatment of postoperative pulmonary complications

Official Title
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Pulmonary Ultrasound to Evaluate Protective Lung Ventilation in Obese Patients With Postoperative Pulmonary Complications Impact

Conditions
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Assessment

Intervention / Treatment
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* Behavioral: recruitment maneuvers


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: enrollment of patients aged 18 years or above； Eligible adult patients had an American Society of Anesthesiologists (ASA) physical status classification of I to IV undergoing elective or expedited nonurgent, noncardiac surgery with general anesthesia Exclusion Criteria: patient refusal; morbid obesity (BMI >40 kg/ m²); American Society of Anesthesiologists (ASA) physical status categories IV-V; previous intrathoracic procedure; severechronic obstructive pulmonary disease (forced expiratory volume in 1 s <30% of the predicted value; a contraindication to radial artery cannulation.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| PEEP<br>The patient was admitted to the operating room, and routine ECG monitoring was performed. The patient was placed in supine position, and ultrasound lung examination was performed. The images of the patient were saved and the score of lung ventilation area was recorded. The induction of general anesthesia was started, and endotracheal intubation was performed after 3min of preoxygenation (100% O2) to establish a safe and effective artificial airway.Mechanical ventilation was performed after endotracheal intubation, and a second time was performed immediately after endotracheal intubation was completed.Pulmonary ultrasound was performed. The PEEPgroup was given the first RM (pulmonary retraction) with pressure maintained at 40cmH2O for 30s, followed by a 7cmH2O PEEP to maintain mechanical ventilation, and the RMS was repeated every 30 minutes until the end of surgery | Behavioral: recruitment maneuvers<br>* Immediately after endotracheal intubation is completed First RM (pulmonary retraction), maintain pressure at 40cmH2O for 30s, and then Mechanical ventilation was maintained with 7cmH2O PEEP, and the RMS was repeated every 30 minutes until the end of surgery<br>|
| ZEEP<br>The patient was admitted to the operating room, and routine ECG monitoring was performed. The patient was placed in supine position, and ultrasound lung examination was performed. The images of the patient were saved and the score of lung ventilation area was recorded. The induction of general anesthesia was started, and endotracheal intubation was performed after 3min of preoxygenation (100% O2) to establish a safe and effective artificial airway. Mechanical ventilation was performed after endotracheal intubation, and a second time was performed immediately after endotracheal intubation was completed On pulmonary ultrasound, patients in the ZEEP group maintained normal mechanical ventilation throughout the operation without PEEP or RMS | Behavioral: recruitment maneuvers<br>* Immediately after endotracheal intubation is completed First RM (pulmonary retraction), maintain pressure at 40cmH2O for 30s, and then Mechanical ventilation was maintained with 7cmH2O PEEP, and the RMS was repeated every 30 minutes until the end of surgery<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lung ultrasound scoring | Four signs were used in lung ultrasound scoring Lung ultrasound score: N (0): pleural line and A line, less than 3 B lines; B1 (1 mark): More than 3 B line; B2 (2 points): Fuse line B; C (3 points): Signs of lung consolidation. The higher the score is, the worse the pulmonary ventilation status is. When scoring, the sign with the greatest severity is taken as the score value of the examination area. There are 12 examination areas in both lungs, so we have a LUS The score is between 0 and 36 | in the morning of the first day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Results of arterial blood gas analysis | PCO2 | entering the operating room, in the morning of the first day ,the second day , the third day after surgery | 
| Mechanical ventilation parameter | peak inspiratory pressure | entering the operating room, in the morning of the first day ,the second day , the third day after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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lung ultrasound, Protective pulmonary ventilation, Postoperative pulmonary complications