scholarly journals The effects of protective lung ventilation on regional cerebral oxygen saturation in intracranial tumor operation during dura opening：study protocol for a randomized controlled trial.

2019 ◽  
Author(s):  
Jinlu Li ◽  
Xuemei Wu ◽  
Hairui Liu ◽  
Ying Huang ◽  
Yueqin Liu ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Controlled Trial ◽  
Lung Ventilation ◽  
Intracranial Tumor ◽  
Cerebral Oxygen Saturation ◽  
Cerebral Oxygen ◽  
Regional Cerebral Oxygen Saturation ◽  
Predicted Body Weight ◽  
Brain Relaxation ◽  
Protective Lung Ventilation

Abstract Objective: To investigate the effects of protective lung ventilation on regional cerebral oxygen saturation during dura opening, that is from Ta (after dura opening) to Tb (before dura closing), in patients undergoing intracranial tumor surgery. Methods: This is a randomized, controlled trial which will be carried out at the second affiliated hospital of Soochow University. Fifty-four patients undergoing intracranial tumor surgery will be randomly allocated to the control group (C group) or the protective lung ventilation group (P group). In the C group, tidal volume (VT) will be set at 8 ml/kg of predicted body weight, but positive end-expiratory pressure (PEEP) and recruitment maneuvers will not be used. In the P group, VT will be set at 6 ml/kg of predicted body weight combined with individualized PEEP during dura opening, while in other periods of general anesthesia, VT will be set at 8 ml/kg of predicted body weight. Regional cerebral oxygen saturation (rSO2), partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2), oxygenation index (OI), lactic acid level (Lac) in arterial blood, and mean arterial pressure (MAP) will be compared before anesthesia (T0), before dura opening (T1), after dura closing (T2) and 24 h after surgery (T3). Lung ultrasound scores (LUS) will be performed at T0 and T3. The degree of brain relaxation at T1 and T2 will be evaluated by the surgeon using the brain relaxation scale. Amount of vasoactive drugs used and blood loss will be recorded during surgery. The duration of operation and reoperation rate will be recorded.The primary outcome of this study is the changes in rSO2 within 24 hours postoperatively. Discussion: This study aims to determine whether protective lung ventilation during dura opening can improve regional cerebral oxygen saturation and the state of pulmonary ventilation in patients undergoing intracranial tumor surgery, and to investigate whether this strategy does not affect the degree of brain tissue swelling and the reoperation rate after operation. If our results are positive, this study will show that protective lung ventilation during dura opening can be used effectively and safely in neurosurgical patients undergoing craniotomy for tumor resection. Trial registration: chictr.org.cn, ID: ChiCTR1900025632. Registered on 3 September 2019. Study protocol version3.0. Keywords: Randomized controlled trial, Regional cerebral oxygen saturation, Lung ultrasound, Brain relaxation, Craniotomy

scholarly journals The effects of protective lung ventilation on regional cerebral oxygen saturation in intracranial tumor operation during dura opening：study protocol for a randomized controlled trial.

2019 ◽  
Author(s):  
Jinlu Li ◽  
Xuemei Wu ◽  
Hairui Liu ◽  
Ying Huang ◽  
Yueqin Liu ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Controlled Trial ◽  
Lung Ventilation ◽  
Intracranial Tumor ◽  
Cerebral Oxygen Saturation ◽  
Cerebral Oxygen ◽  
Regional Cerebral Oxygen Saturation ◽  
Predicted Body Weight ◽  
Brain Relaxation ◽  
Protective Lung Ventilation

Abstract Abstract Objective: To investigate the effects of protective lung ventilation on regional cerebral oxygen saturation during dura opening, that is from Ta (after dura opening) to Tb (before dura closing), in patients undergoing intracranial tumor surgery. Methods: This is a randomized, controlled trial which will be carried out at the second affiliated hospital of Soochow University. Fifty-four patients undergoing intracranial tumor surgery will be randomly allocated to the control group (C group) or the protective lung ventilation group (P group). In the C group, tidal volume (VT) will be set at 8 ml/kg of predicted body weight, but positive end-expiratory pressure (PEEP) and recruitment maneuvers will not be used. In the P group, VT will be set at 6 ml/kg of predicted body weight combined with individualized PEEP during dura opening, while in other periods of general anesthesia, VT will be set at 8 ml/kg of predicted body weight. Regional cerebral oxygen saturation (rSO2), partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2), oxygenation index (OI), lactic acid level (Lac) in arterial blood, and mean arterial pressure (MAP) will be compared before anesthesia (T0), before dura opening (T1), after dura closing (T2) and 24 h after surgery (T3). Lung ultrasound scores (LUS) will be performed at T0 and T3. The degree of brain relaxation at T1 and T2 will be evaluated by the surgeon using the brain relaxation scale. Amount of vasoactive drugs used and blood loss will be recorded during surgery. The duration of operation and reoperation rate will be recorded. Discussion: This study aims to determine whether protective lung ventilation during dura opening can improve regional cerebral oxygen saturation and the state of pulmonary ventilation in patients undergoing intracranial tumor surgery, and to investigate whether this strategy does not affect the degree of brain tissue swelling and the reoperation rate after operation. If our results are positive, this study will show that protective lung ventilation during dura opening can be used effectively and safely in neurosurgical patients undergoing craniotomy for tumor resection. Trial registration: chictr.org.cn, ID: ChiCTR1900025632. Registered on 3 September 2019. Study protocol version 2.0. Keywords: Randomized controlled trial, Regional cerebral oxygen saturation, Lung ultrasound, Brain relaxation, Craniotomy

scholarly journals The effects of protective lung ventilation on regional cerebral oxygen saturation in intracranial tumor operative during dura opening：study protocol for a randomized controlled trial

2019 ◽  
Author(s):  
Jinlu Li ◽  
Xuemei Wu ◽  
Hairui Liu ◽  
Ying Huang ◽  
Yueqin Liu ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Lung Ventilation ◽  
Ideal Body Weight ◽  
Intracranial Tumor ◽  
Cerebral Oxygen Saturation ◽  
Cerebral Oxygen ◽  
Regional Cerebral Oxygen Saturation ◽  
Ideal Body ◽  
Pulmonary Protection ◽  
Protective Lung Ventilation

Abstract Objective:To investigate the effects of protective lung ventilation on regional cerebral oxygen saturation during dura opening, that is from after dura opening (T1a) to before dura closing (T2b), in patients undergoing intracranial tumor surgery. Methods: This is a randomized, controlled trial which will be carried out at the second affiliated hospital of Soochow University. Fifty-four patients undergoing intracranial tumor surgery will be randomly allocated to the control group and the protective lung ventilation group. In the control group, tidal volume (VT) will be set at 8 ml/kg of ideal body weight, but positive end-expiratory pressure (PEEP) and recruitment maneuvers will not be used. In the protective lung ventilation group, VT will be set at 6 ml/kg of ideal body weight combined with individualized PEEP (PEEPx) during intraoperative dura mater opening, but in other periods of general anesthesia, VT will be set at 8 ml/kg of ideal body weight. Titration method of individualized PEEP (PEEPx) [1]: VT and respiratory rate will be fixed at 6ml/kg and 15 beats per minute during PEEP trial. Titration can only begin once the dura is opened. The titration for the individual PEEP can then be initiated by increasing PEEP from 2 to 10cm H2O incrementally. Each PEEP level (2, 3, 4, 5, 6, 7, 8, 9, 10cm H2O) will be maintained for 1 minute, and the pulmonary compliance of the last cycle will be recorded at each PEEP level. At last, the PEEP value at the highest compliance will be selected as the individual PEEP of patient. Regional cerebral oxygen saturation (rSO2), partial pressure of oxygen and carbon dioxide, oxygenation index, lactic acid level in arterial blood, and mean arterial pressure will be compared before anesthesia (T0), before dura opening (T1), after dura closing (T2) and 24 h after surgery (T3). Pulmonary ultrasound scores will be performed at T0 and T3.The degree of brain relaxation before and after protective lung ventilation will be evaluated by the surgeon using the brain relaxation scale. Amount of vasoactive drugs used and blood loss will be recorded during intraoperative dura mater opening. The total duration and secondary rate of surgery also will be recorded. Discussion: This study aims to determine whether intraoperative pulmonary protection strategy can improve regional cerebral oxygen saturation in patients undergoing intracranial tumor surgery, and to investigate whether intraoperative pulmonary protection strategy does not affect the degree of brain tissue swelling and the amount of blood loss during surgery. If our results are positive, this study will show that intraoperative pulmonary protection strategy can be used effectively and safely in neurosurgical patients undergoing craniotomy for tumor resection. Trial registration: chictr.org.cn, ID: ChiCTR1900025632. Registered on 3 September 2019. tudy protocol version 1.0.

scholarly journals The effects of ventilation on left-to-right shunt and regional cerebral oxygen saturation: a self-controlled trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Peiyi Li ◽  
Jun Zeng ◽  
Wei Wei ◽  
Jing Lin
Keyword(s):  
Oxygen Saturation ◽  
Near Infrared ◽  
Controlled Trial ◽  
Cerebral Oxygen Saturation ◽  
Patient Specific ◽  
Cerebral Oxygen ◽  
Regional Cerebral Oxygen Saturation ◽  
Observation Study ◽  
Arterial Blood ◽  
Stabilization Period

Abstract Background Increase of pulmonary vascular resistance (PVR) is an efficient method of modulating pulmonary and systemic blood flows (Qp/Qs) for patients with left-to-right (L-R) shunt, and is also closely associated with insufficient oxygen exchange for pulmonary hypoperfusion. So that it might be a preferred regime of maintaining arterial partial pressure of carbon dioxide tension (PaCO2) within an optimal boundary via ventilation management in congenital heart disease (CHD) patients for the inconvenient measure of the PVR and Qp/Qs. However, the appropriate range of PaCO2 and patient-specific mechanical ventilation settings remain controversial for CHD children with L-R shunt. Methods Thirty-one pediatric patients with L-R shunt, 1–6 yr of age, were included in this observation study. Patients were ventilated with tidal volume (VT) of 10, 8 and 6 ml/kg in sequence, and 15 min stabilization period for individual VT. The velocity time integral (VTI) of L-R shunt, pulmonary artery (PA) and descending aorta (DA) were measured with transesophageal echocardiography (TEE) after an initial 15 min stabilization period for each VT, with arterial blood gas analysis. Near-infrared spectroscopy sensor were positioned on the surface of the bilateral temporal artery to monitor the change in regional cerebral oxygen saturation (rScO2). Results PaCO2 was 31.51 ± 0.65 mmHg at VT 10 ml/kg vs. 37.15 ± 0.75 mmHg at VT 8 ml/kg (P < 0.03), with 44.24 ± 0.99 mmHg at VT 6 ml/kg significantly higher than 37.15 ± 0.75 mmHg at VT 8 ml/kg. However, PaO2 at a VT of 6 ml/kg was lower than that at a VT of 10 ml/kg (P = 0.05). Meanwhile, 72% (22/31) patients had PaCO2 in the range of 40-50 mmHg at VT 6 ml/kg. VTI of L-R shunt and PA at VT 6 ml/kg were lower than that at VT of 8 and 10 ml/kg (P < 0.05). rScO2 at a VT of 6 ml/kg was higher than that at a VT of 8 and 10 ml/kg (P < 0.05), with a significantly correlation between rScO2 and PaCO2 (r = 0.53). VTI of PA in patients with defect diameter > 10 mm was higher that that in patients with defect diameter ≤ 10 mm. Conclusions Maintaining PaCO2 in the boundary of 40-50 mmHg with VT 6 ml/kg might be a feasible ventilation regime to achieve better oxygenation for patients with L-R shunt. Continue raising PaCO2 should be careful. Trail registration Clinical Trial Registry of China (http://www.chictr.org.cn) identifier: ChiCTR-OOC-17011338, prospectively registered on May 9, 2017.

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