Comparing Innovative and Traditional Ventilation Strategies on Atelectasis and Prognosis in Elderly Patients

Summary

This study was divided into two parts, taking elderly patients undergoing general anesthesia surgery as the research subjects, through factorial design: 1. It was verified that in elderly patients undergoing general anesthesia surgery, innovative lung-protective ventilation strategies can reduce the occurrence of atelectasis and reduce the incidence of ventilator-related lung injury and postoperative pulmonary complications more than traditional lung-protective ventilation strategies; 2. On the basis of part one study proving that innovative lung-protective ventilation strategies can reduce the incidence of postoperative atelectasis and other complications in elderly patients undergoing general anesthesia surgery compared with traditional lung-protective ventilation strategies, further comparisons were made between the two factors of "positive pressure extubation" and "improved early postoperative respiratory training" in the innovative lung protective ventilation strategy, and whether there was an interaction between the two.

Conditions

• Ventilator-associated Lung Injury
• Atelectasis
• Postoperative Pulmonary Complications

Interventions

PROCEDURE

Traditional ventilation strategies

1. Tidal volume：10ml/kg predicted body weight（PBW）； 2. 0 cm H2O positive end expiratory pressure（PEEP）； 3. negative pressure extubation

PROCEDURE

Traditional lung-protective ventilation strategies

1. Tidal volume：6ml/kg PBW； 2. 5cmH2O PEEP； 3. Ventilator-controlled recruitment manoeuvre； 4. CPAP； 5. negative pressure extubation

PROCEDURE

Innovative lung-protective ventilation strategies

1. Tidal volume：6ml/kg PBW； 2. 5cmH2O PEEP； 3. positive pressure extubation； 4. postoperative breathing training

PROCEDURE

Lung-protective ventilation

1. Tidal volume：6ml/kg PBW； 2. 5cmH2O PEEP；

PROCEDURE

negative pressure extubation

The suction tube is inserted into the endotracheal tube, continuous negative pressure suction, and at the same time that the balloon is completely deflated, the suction tube, dental pad and endotracheal intubation are pulled out at the same time, and then the patient is instructed to cough independently and remove sputum.

PROCEDURE

positive pressure extubation

The adjustable pressure limiting（APL）was adjusted to 30cm H2O, and after the patient breathed spontaneously until the peak airway pressure reached 30cm H2O, and after maintaining this level for 10s, the balloon was quickly cut off to remove the endotracheal tube, so that the patient had an autonomous coughing action, and then the oral sputum was removed.

PROCEDURE

postoperative breathing training

Inhale deeply through the nose, hold the breath for 5s, and then slowly spit out the breath through the mouth, cycle 5-6 times, and inflate the balloon. The above steps need to be performed 15 times within 24 hours after surgery.

Sponsors & Collaborators

• The First Affiliated Hospital of Nanchang University

  collaborator OTHER

• The First Hospital of Putian City, Putian, Fujian

  collaborator OTHER_GOV

• Fujian Medical University Union Hospital

  lead OTHER

Principal Investigators

• Zhongmeng Lai · Fujian Medical University Union Hospital

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Model

FACTORIAL

Eligibility

Min Age

60 Years

Max Age

100 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2021-09-28

Primary Completion

2023-12-31

Completion

2024-06-30

Countries

• China

Study Locations