IMPREMO: Impact of Lung Recruitment Maneuvers on Driving Pressure in Cardiac Surgery
Study Details
Study Description
Brief Summary
In anesthesia the incidence of postoperative pulmonary complications is frequent, especially in cardiac surgery where the incidence can reach 10%. Respiratory morbidity in cardiac surgery is favored by multiple factors and is higher compared to anesthesia in "general" surgery. The prevention of these complications is a major challenge in the management of patients.
Influence of driving pressure level on respiratory morbidity was first demonstrated in management of acute respiratory distress syndrome (ARDS) in resuscitation.
More recently, this notion has been introduced in anesthesia, with a correlation between increase driving pressure level and increase of post-operative respiratory complications.
A method should reduce these levels of driving pressure: performing lung recruitment maneuvers. This technique has been successfully tested in abdominal surgery in particular in a study published by Futier et al.. They systematized and standardized lung recruitment maneuvers and showed a decrease of postoperative pulmonary complications in abdominal surgery.
Thus, the realization of lung recruitment maneuvers, already used at the discretion of the practitioner, is now recommended by several teams of experts. The investigators propose in this "before-after" trial to evaluate variation in driving pressure due to systematic use of lung recruitment maneuvers, observed in patients operated in elective or urgent surgery. The secondary objective is to evaluate their impact on postoperative pulmonary complications.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
This is a retrospective, before / after, monocentric trial.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Before group The "before" group is the control group. We collect retrospective data in consecutive patients operated before the implementation of lung recruitment maneuvers protocol |
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| After group We collect data in consecutive patients operated after the implementation of lung recruitment maneuvers protocol. This lung recruitment maneuvers will be realised along the surgery, (After tracheal intubation, per-CPB, post-CPB). Each recruitment maneuver consisted of applying a continuous positive airway pressure of 30 cm of water for 30 seconds |
Outcome Measures
Primary Outcome Measures
- Driving pressure variation due to lung recruitment maneuvers [1 day]
cmH2O
Secondary Outcome Measures
- Incidence of postoperative pulmonary complications [baseline]
percentage
Eligibility Criteria
Criteria
Inclusion Criteria:
- Patients receiving elective or urgent cardiac surgery with cardiopulmonary bypass
Exclusion Criteria:
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Emergency or salvage surgery
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Patient under guardianship
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Pregnancy
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Caen University Hospital | Caen | France | 14000 |
Sponsors and Collaborators
- University Hospital, Caen
Investigators
- Principal Investigator: Jennifer Brunet, MD, University Hospital of Caen
Study Documents (Full-Text)
None provided.More Information
Publications
- Futier E, Constantin JM, Paugam-Burtz C, Pascal J, Eurin M, Neuschwander A, Marret E, Beaussier M, Gutton C, Lefrant JY, Allaouchiche B, Verzilli D, Leone M, De Jong A, Bazin JE, Pereira B, Jaber S; IMPROVE Study Group. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013 Aug 1;369(5):428-37. doi: 10.1056/NEJMoa1301082.
- Neto AS, Hemmes SN, Barbas CS, Beiderlinden M, Fernandez-Bustamante A, Futier E, Gajic O, El-Tahan MR, Ghamdi AA, Günay E, Jaber S, Kokulu S, Kozian A, Licker M, Lin WQ, Maslow AD, Memtsoudis SG, Reis Miranda D, Moine P, Ng T, Paparella D, Ranieri VM, Scavonetto F, Schilling T, Selmo G, Severgnini P, Sprung J, Sundar S, Talmor D, Treschan T, Unzueta C, Weingarten TN, Wolthuis EK, Wrigge H, Amato MB, Costa EL, de Abreu MG, Pelosi P, Schultz MJ; PROVE Network Investigators. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data. Lancet Respir Med. 2016 Apr;4(4):272-80. doi: 10.1016/S2213-2600(16)00057-6. Epub 2016 Mar 4. Review. Erratum in: Lancet Respir Med. 2016 Jun;4(6):e34.
- 17-023