Atelectasis

Researchers are evaluating the effects of heated humidified high flow nasal cannula (HFNC) oxygen therapy compared to conventional nasal cannula oxygen therapy in patients with gynecologic tumors who are at high risk for post-operative pulmonary complications (PPC). The study focuses on women undergoing gynecological surgery and aims to measure the occurrence of PPC such as postoperative hypoxemia, atelectasis, and pneumonia. Secondary outcomes include improvements in postoperative oxygenation, antibiotic use, length of hospital stay, and any adverse events related to oxygen therapy. Participants are randomly assigned to one of two groups: the HFNC group receives heated humidified high flow nasal cannula oxygen therapy on the day of surgery and the first day after surgery, with oxygen saturation maintained between 92% and 95%. The control group receives conventional nasal cannula oxygen therapy during the same time frame, also maintaining oxygen saturation at 92% to 95%. Both groups have chest CT scans reviewed 36 to 48 hours after surgery. The HFNC device can provide oxygen concentrations ranging from 21% to 100% with heated and humidified gas at 37°C and a maximum flow of 70 liters per minute. During the study, participants will be monitored for postoperative pulmonary complications over seven days after surgery. Researchers will also assess total hospitalization days, oxygen therapy usage, antibiotic use, postoperative oxygenation, and any adverse events within two to seven days post-surgery. The study includes scheduled chest CT scans and continuous oxygen saturation monitoring to track participant outcomes. The study is sponsored by Sichuan Cancer Hospital and Research Institute and is expected to continue until the end of 2025.

Researchers are investigating the impact of automated intraoperative lung recruitment maneuvers on the occurrence of atelectasis in adult patients undergoing major laparoscopic colorectal cancer surgery. Laparoscopic colorectal surgery can increase the risk of lung collapse during and after surgery due to factors like pneumoperitoneum, patient positioning, and long anesthesia times. This trial aims to compare automated lung recruitment with standard ventilation to see if it reduces atelectasis and postoperative lung complications. Participants will be randomly assigned to one of two groups: one receiving standard mechanical ventilation without lung recruitment maneuvers, and the other receiving automated lung recruitment maneuvers delivered by the anesthesia ventilator twice during surgery. The recruitment maneuvers are applied after anesthesia induction and after stopping pneumoperitoneum. Both groups will have standardized fluid management and postoperative care. Throughout the study, lung ultrasonography will be used before, during, and after surgery to detect atelectasis and assess lung aeration. Researchers will monitor outcomes including lung ultrasound scores, postoperative pulmonary complications, hemodynamic stability, and lengths of intensive care and hospital stays. The follow-up includes assessments up to one day after surgery and monitoring for complications until hospital discharge.

Researchers are evaluating the use of portable dynamic digital radiography (DDR), a new advanced chest X-ray technology, in intensive care unit (ICU) patients. DDR captures dynamic images of lung motion, ventilation, and perfusion at a high frame rate, potentially providing more detailed and quantitative lung function information compared to traditional chest X-rays. This trial aims to test the feasibility and safety of portable DDR in the ICU and to compare its diagnostic value with current standard imaging methods. Participants will receive one to three sets of DDR scans, including 7-second breathing and breath-holding scans. These images will be compared to gold standard clinical exams such as chest X-rays, CT scans, or ventilation-perfusion (VQ) scans. The study will observe how DDR performs in diagnosing lung conditions like diaphragmatic dysfunction, pulmonary embolism, and pulmonary edema, alongside routine clinical imaging. Throughout the study, participants will undergo DDR imaging alongside their routine clinical imaging. Researchers will analyze these images to measure lung motion, diaphragmatic movement, and perfusion. The primary outcomes include assessing the precision of DDR in evaluating cardiopulmonary functions related to the diaphragm and lung motion as well as pulmonary blood flow, over a period of up to two months. The study will monitor safety and diagnostic accuracy while patients receive standard care.

This research aims to find out if using diaphragm ultrasound to measure diaphragm thickening fraction, excursion, and density before and after major abdominal, pelvic, or vascular surgery can predict respiratory complications during the 30 days after surgery. Respiratory complications include pneumonia, desaturation, need for intubation, and other events. The study focuses on adults scheduled for elective or acute surgery and seeks to address the impact of diaphragm dysfunction on postoperative outcomes and recovery. Participants will undergo diaphragm ultrasound exams before surgery and multiple times after surgery in the postoperative ward. This non-invasive and painless imaging uses ultrasound transducers to measure diaphragm movement, thickness, and density. Researchers will also monitor vital signs, oxygen levels, medication, anesthesia details, and surgery data. The study consists of two parts: one with elective surgery patients and one with acute surgery patients, each observed closely for respiratory complications up to 30 days post-surgery. Throughout the study, participants will have their diaphragm assessed using ultrasound at set times before and after surgery, with vital parameters recorded in detail. Researchers will collect data on respiratory complications from medical records and correlate these with the ultrasound findings to evaluate diaphragm function's predictive value. Data security measures will protect ultrasound images and patient information. The study will analyze outcomes like pneumonia occurrence, respiratory insufficiency, and oxygen desaturation to better understand and prevent postoperative respiratory issues.

Researchers are evaluating two different types of perioperative mechanical ventilation (MV) to see which better prevents postoperative pulmonary complications (PPCs) in adult patients at higher risk. The study compares Protective Mechanical Ventilation (PMV), a conventional method with preset lung pressures, to MV using the lowest possible Driving Pressure (ΔP) tailored to individual lung mechanics. The goal is to find if MV with lower ΔP can reduce PPCs, hospital stay length, ICU need, and mortality. Participants will be randomly assigned to one of two groups. One group receives conventional PMV with standard settings including PEEP of 8 cm H2O and tidal volume of 8 ml/kg ideal body weight. The other group receives MV where PEEP is individually adjusted to minimize driving pressure after measuring lung compliance. Both groups receive mechanical ventilation with similar volumes, respiratory rates, inspired oxygen fractions, and hourly recruitment maneuvers during surgery. After surgery, participants will be monitored for PPCs such as atelectasis, respiratory failure, bronchospasm, pleural effusion, pneumonia, aspiration pneumonitis, and pneumothorax using arterial blood tests and chest X-rays. Researchers will also record hospital stay duration, ICU admission and stay, 28-day mortality, and detailed perioperative lung pressure and volume measurements. The study follows patients from the operation day through their hospital stay and up to 28 days postoperatively.

Researchers are investigating the impact of individualized positive end-expiratory pressure (PEEP) guided by driving pressure on reducing postoperative pulmonary atelectasis in patients with morbid obesity undergoing bariatric surgery. Atelectasis is a common complication after surgery under general anesthesia, particularly in obese patients, and can lead to further issues like low oxygen levels and pneumonia. This study is a single-center, randomized controlled trial aiming to assess a novel lung protection strategy during surgery. Participants will be randomly assigned to one of two groups. In the individualized PEEP group, after a recruitment maneuver, PEEP is adjusted downwards based on driving pressure measurements to find the optimal PEEP that minimizes lung pressure, repeated three times at specific surgery stages. The fixed PEEP group receives a constant PEEP of 8 cmH2O after the same maneuver. This approach aims to compare the effectiveness of personalized lung ventilation against a standard fixed setting. During the study, measurements will be taken 30 minutes after extubation to evaluate the incidence of postoperative pulmonary atelectasis and lung ultrasound scores. Patients will be monitored throughout surgery and postoperatively to assess lung function and complications. The total participation includes surgery and immediate postoperative evaluations, with safety and lung protection outcomes carefully recorded to determine the benefit of the individualized ventilation strategy.

Researchers are evaluating whether applying alveolar recruitment maneuvers (ARM) periodically during elective spine surgery in the prone position can reduce lung collapse (atelectasis) and improve breathing mechanics under general anesthesia. This randomized controlled trial involves adult patients undergoing spine surgery lasting at least two hours. The study compares a routine single-time ARM with periodic ARM to see if repeated maneuvers better maintain lung aeration and respiratory function during surgery. Participants are randomly assigned to one of two groups. Both receive standard general anesthesia and ventilation, with a baseline ARM after positioning. The periodic ARM group receives additional recruitment maneuvers approximately once per hour during surgery plus a final ARM before extubation. The standard ARM group receives only the baseline and final ARM. All maneuvers are performed within established safety limits without introducing experimental drugs or devices. During the study, lung aeration is assessed using lung ultrasound at multiple time points, including before extubation. Researchers also monitor respiratory mechanics such as airway pressures, lung compliance, oxygen levels, and any transient respiratory or blood flow changes. The main outcome is the incidence of intraoperative atelectasis before extubation. Monitoring continues into the recovery period to evaluate oxygen levels and lung aeration. The total participation duration depends on surgery and immediate recovery phases.

Researchers are studying the lung-protective effects of ultrasound-guided lung recruitment maneuvers in female patients with obstructive sleep apnea (OSA) undergoing total laparoscopic hysterectomy. The study aims to compare different lung recruitment techniques and explore how measuring end-expiratory lung volume (EELV) helps assess their effectiveness in reducing postoperative pulmonary complications. Participants will be randomly assigned to one of three groups: the sustained inflation recruitment maneuver group, the incremental positive end-expiratory pressure (PEEP) recruitment maneuver group, or the ultrasound-guided recruitment maneuver group. Each group receives a specific procedure involving adjustments to airway pressure and timing during surgery to improve lung function. The ultrasound-guided group uses lung ultrasound to target areas of reduced aeration and guide treatment. Throughout the study, lung ultrasound scores will be measured at five time points: after intubation, after the first recruitment maneuver, after surgery, after the second recruitment maneuver, and 30 minutes after extubation. Additionally, lung volume changes using the EELV method will be recorded. These assessments help evaluate lung aeration and function. Participants' safety and lung condition will be closely monitored during and after surgery, with the study expected to end by August 2026.

Researchers are studying patients undergoing elective coronary artery bypass surgery to evaluate how well fluid responsiveness can be predicted after sternotomy using lung recruitment maneuvers and protective lung ventilation. The study focuses on assessing the reliability of dynamic indices such as pulse pressure variation (PPV) and stroke volume variation (SVV) in this setting to better predict fluid response. The goal is to improve management of fluid therapy in patients ventilated with 6 ml/kg of ideal body weight. During the study, patients will have their stroke volume index, cardiac index, and mean arterial pressure measured while lying in the lima position. Then, a lung opening maneuver applying 30 mmHg pressure for 30 seconds will be performed, followed by repeated measurements. After values return to normal, patients will receive balanced fluid at 3 ml/kg, and measurements will be recorded again to assess fluid responsiveness. Participants will be monitored from the start through four months to determine fluid responsiveness after surgery. The study involves careful observation of cardiovascular parameters before and after the lung recruitment maneuver and fluid administration. Researchers will gather data to understand the sensitivity and specificity of PPV and SVV changes in this context.

Researchers are studying the use of high frequency oscillatory ventilation (HFOV) to help open the lungs in preterm newborns born between 32 and 37 weeks gestational age who have moderate to severe breathing difficulties. The study also aims to compare chest ultrasound with routine chest X-rays to monitor lung opening and to assess heart function using functional echocardiography. This research is focused on improving care for these vulnerable infants by evaluating these monitoring methods and ventilation support. The study involves preterm infants who require invasive breathing support through HFOV within the first 24 hours of life. Researchers will use chest ultrasound and echocardiography to monitor lung recruitment and heart blood flow during this treatment. The main study period covers the first three days after birth when these assessments will be performed to evaluate lung and heart function. Participants will undergo chest ultrasound exams and heart flow measurements during the initial three days of life. The study will measure lung recruitment using ultrasound, blood flow through the superior vena cava, and estimated pulmonary artery pressure. These assessments will help researchers understand the effects of HFOV on lung opening and heart function in preterm babies. The total participation time is around three days with ongoing monitoring during this period.