Alveolar Recruitment Maneuvers on Reduction of Lung Atelectasis in Bariatric Surgery by Using Lung Ultrasound Score

Study Overview
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Brief Summary
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The study aims to compare the staircase alveolar recruitment maneuver with PEEP titration versus sustained inflation alveolar recruitment maneuver by using lung ultrasound score as an indicator of improving lung atelectasis in bariatric surgery

Detailed Description
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Weight loss surgery, often known as bariatric surgery, is an effective obesity treatment. Most people undergoing such surgery may show an improvement in, or the resolution of, conditions such as diabetes, dyslipidemia, hypertension, and obstructive sleep apnea. Currently, there is no standard ventilation strategy has been established for obese patients. However, there is some evidence that recruitment maneuvers (RM) combined with protective lung ventilation strategy improve oxygenation and compliance compared to other strategies. Alveolar recruitment maneuver refers to the periodic hyperinflation of the lungs that has been utilized to open up the lung and keep the lung open in anesthetized patients. The use of recruitment maneuvers has been shown to reduce the incidence and extent of atelectasis during general anesthesia by different methods. Lung ultrasonography is considered a useful tool in perioperative care. Recent research showed that lung ultrasound could assess lung aeration and diagnose anesthesia-induced atelectasis accurately in the perioperative period by measuring the extent of atelectasis by the scoring system; also, the response to recruitment manoeuver for each patient can be evaluated easily. Thus, it has great potential as a bedside non-invasive, sensitive tool for guiding effective recruitment manoeuvers to reduce the formation of pulmonary atelectasis in the surgical setting

Official Title
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Comparison Between Two Alveolar Recruitment Maneuvers on Reduction of Lung Atelectasis in Bariatric Surgery by Using Lung Ultrasound Score

Conditions
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Alveolar Recruitment Maneuvers, Atelectasis, Bariatric Surgery

Intervention / Treatment
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* Procedure: Lachmann maneuver
* Procedure: Staircase maneuver


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult morbidly obese patients (Body mass index < 40kg / m2 or Body mass index < 35kg / m2 with obesity-related comorbidities such as hypertension, diabetes, and sleep apnea) undergo elective bariatric laparoscopic surgery with an expected duration of at least one hour under general anesthesia. Exclusion Criteria: Patient refusal to participate in the study. Patients with a previous history of thoracic surgery. Patients with a history of chest disease (COPD, emphysema, or pneumothorax). Patients with abnormal pre-operative chest radiographs such as pneumonia, pleural effusion. Patients with heart failure or impending failure. Patients with known hypovolemia. Patients with increased intracranial pressure.

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Lachmann maneuver<br>Patients undergone the Lachmann recruitment maneuver (30 CmH2O PEEP for 30 seconds) | Procedure: Lachmann maneuver<br>* Patients undergone the Lachmann recruitment maneuver (30 CmH2O PEEP for 30 seconds)<br>|
| Active Comparator: Staircase maneuver<br>Patients undergone staircase recruitment maneuver (stepped increase in PEEP by 2 CmH2O every five breaths until reach upper deflection point | Procedure: Staircase maneuver<br>* Patients undergone Undergone staircase recruitment maneuver (stepped increase in PEEP by 2 CmH2O every five breaths until reach upper deflection point<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improvement of Lung ultrasound score. | Access lung ultrasound score at the end of surgery | 48 hours postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Access Pulmonary complications | Pulmonary complications were measured as (pneumonia, pulmonary edema, pleural effusion, and pneumothorax). | 48 hours postoperatively | 
| Access incidence of oxygen desaturation | incidence of oxygen desaturation was measured | 48 hours Postoperatively | 
| Access Complications of recruitment maneuver | Complications of recruitment maneuver including bradycardia, hypotension were measured | 48 hours Postoperatively |