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 37C 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 functions 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 P tailored to individual lung mechanics. The goal is to find if MV with lower P 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 mlkg 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 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 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.

Researchers are evaluating the relationship between intraoperative paravertebral nerve blocks and the reduction of complications after thoracic surgery. This observational study includes both retrospective and prospective parts and focuses mainly on patients undergoing pulmonary and mediastinal thoracic surgeries. The goal is to explore how this nerve block might influence postoperative outcomes and identify related biochemical markers. Participants are divided into two groups one receives a paravertebral nerve block under ultrasound guidance during surgery targeting the thoracic vertebrae related to the surgical site, using standard local anesthetics. The other group receives standard pain management without the nerve block, following usual institutional protocols. Both groups undergo thoracic surgery with standard anesthesia and monitoring. Retrospective data from previous surgeries with nerve blocks will also be analyzed. During the prospective part, researchers will collect biochemical markers like MMP3, neutrophils, leukocytes, PCT, and CRP around the surgery time. They will assess postoperative pain and cough scores, and record time to first flatus and defecation at 24 and 48 hours after surgery. Participants will be followed for 30 days to track complications. The study aims to correlate biomarkers with clinical outcomes to evaluate prognosis after thoracic surgery.

Researchers are investigating the best extubation method to reduce lung complications after surgery. The study compares two techniques called open lung and conventional extubation in adults undergoing planned abdominal surgery with general anesthesia. The goal is to find out which method better keeps the lungs open and reduces breathing problems after surgery, as current evidence is unclear and imaging studies show benefits may be lost quickly after extubation. Participants will be randomly assigned to one of two groups one using the open lung extubation strategy, where patients are semi-sitting with 50% oxygen and pressure support ventilation while keeping positive pressure in the lungs the other using the conventional method, where patients lie on their backs with 100% oxygen and manual or assisted breathing without positive pressure. The study follows a controlled, double-blind design across several Canadian hospitals. During the study, researchers will monitor how well the extubation protocols are followed, the rate of patient recruitment each week, and the completion of lung complication assessments at seven days after surgery. Additional evaluations include recovery quality, oxygen needs after surgery, hospital discharge outcomes, and health-related quality of life up to 90 days. The study is planned to last about nine months, with careful tracking of lung function and patient progress throughout.