Open Lung Protective Extubation Following General Anesthesia

Summary

Perioperative respiratory complications are a major source of morbidity and mortality. Postoperative atelectasis plays a central role in their development. Protective "open lung" mechanical ventilation aims to minimize the occurrence of atelectasis during the perioperative period. Randomized controlled studies have been performed comparing various "open lung" ventilation protocols, but these studies report varying and conflicting effects. The interpretation of these studies is complicated by the absence of imagery supporting the pulmonary impact associated with the use of different ventilation strategies. Imaging studies suggest that the gain in pulmonary gas content in "open lung" ventilation regimens disappears within minutes after the extubation. Thus, the potential benefits of open-lung ventilation appear to be lost if, at the time of extubation, no measures are used to keep the lungs well aerated. Recent expert recommendations on good mechanical ventilation practices in the operating room conclude that there is actually no quality study on extubation.

Extubation is a very common practice for anesthesiologists as part of their daily clinical practice. It is therefore imperative to generate evidence on good clinical practice during anesthetic emergence in order to potentially identify an effective extubation strategy to reduce postoperative pulmonary complications.

Conditions

• Intra-abdominal Surgery
• Anesthesia
• Lung Injury
• Ventilator-Induced Lung Injury
• Atelectasis

Interventions

OTHER

Protective "open-lung" extubation

Emergence using 50% FiO2, semi-sitting position with pressure support ventilation and preserved PEEP

OTHER

Conventional extubation

Emergence using 100% FiO2, dorsal decubitus position with assistance or manual bag ventilation without PEEP

Sponsors & Collaborators

• CHU de Quebec-Universite Laval

  collaborator OTHER

• The Ottawa Hospital

  collaborator OTHER

• University Health Network, Toronto

  collaborator OTHER

• Canadian Institutes of Health Research (CIHR)

  collaborator OTHER_GOV

• Centre hospitalier de l'Université de Montréal (CHUM)

  lead OTHER

Principal Investigators

• Martin Girard, MD · Centre hospitalier de l'Université de Montréal (CHUM)

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2024-10-08

Primary Completion

2026-12-01

Completion

2027-04-01

Countries

• Canada

Study Locations