Journal
TRIALS
Volume 21, Issue 1, Pages -Publisher
BMC
DOI: 10.1186/s13063-020-4075-z
Keywords
Mechanical ventilation; Intraoperative ventilation; Delta P; Compliance; Positive end-expiratory pressure; Recruitment maneuver; Pulmonary complications; Postoperative complications; Postoperative pulmonary complications
Categories
Funding
- The Netherlands Organization for health Research and Development (ZonMw)
- Amsterdam University Medical Centers, AMC
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Background Intraoperative driving pressure (Delta P) is associated with development of postoperative pulmonary complications (PPC). When tidal volume (V-T) is kept constant, Delta P may change according to positive end-expiratory pressure (PEEP)-induced changes in lung aeration. Delta P may decrease if PEEP leads to a recruitment of collapsed lung tissue but will increase if PEEP mainly causes pulmonary overdistension. This study tests the hypothesis that individualized high PEEP, when compared to fixed low PEEP, protects against PPC in patients undergoing open abdominal surgery. Methods The Driving prESsure durIng GeNeral AnesThesIa for Open abdomiNal surgery trial (DESIGNATION) is an international, multicenter, two-group, double-blind randomized clinical superiority trial. A total of 1468 patients will be randomly assigned to one of the two intraoperative ventilation strategies. Investigators screen patients aged >= 18 years and with a body mass index <= 40 kg/m(2), scheduled for open abdominal surgery and at risk for PPC. Patients either receive an intraoperative ventilation strategy with individualized high PEEP with recruitment maneuvers (RM) (individualized high PEEP) or one in which PEEP of 5 cm H2O without RM is used (low PEEP). In the individualized high PEEP group, PEEP is set at the level at which Delta P is lowest. In both groups of the trial, V-T is kept at 8 mL/kg predicted body weight. The primary endpoint is the occurrence of PPC, recorded as a collapsed composite of adverse pulmonary events. Discussion DESIGNATION will be the first randomized clinical trial that is adequately powered to compare the effects of individualized high PEEP with RM versus fixed low PEEP without RM on the occurrence of PPC after open abdominal surgery. The results of DESIGNATION will support anesthesiologists in their decisions regarding PEEP settings during open abdominal surgery.
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