Atelectasis Frequency in Different Ventilation Modes

NCT06430229 | Completed

• 1 other identifier: AEŞH-BADEK-2024-152
• Study Type: interventional
• Target: 110
• Locations: 1 country
• Sites: 1

Brief Summary

General anesthesia is characterized by temporary loss of consciousness and decreased reflex activity without any change in vital functions. It can be performed with intravenous and/or inhalation agents. During general anesthesia, breathing is stopped and respiratory support is provided to patients with various respiratory equipment and ventilation modes on the anesthesia device. The most commonly used ventilation modes during anesthesia are volume controlled (VCV) and pressure controlled (PCV). In pressure-controlled ventilation, ventilation is provided with the airway pressure determined by the anesthesiologist throughout inspiration. While the pressure is constant during inspiration, the tidal volume is variable. In volume controlled ventilation, ventilation executed at the volume is set by the anesthesiologist. In other words, the determined volume is constant, but airway pressures vary. In pediatric anesthesia practice modes have not been shown to have a clear advantage over each other. Both modes have advantages and disadvantages. With the development of modern anesthesia devices in recent years, safe ventilation can be provided even in very young children with volume controlled mode (VCV). Atelectasis is the restriction of gas exchange due to complete or partial collapse of the lung. Atelectasis can be seen in 90 percent of patients receiving general anesthesia. This incidence is reported to be 68-100 percent in children. Lung ultrasonography is an imaging method with many advantages for imaging lung-related diseases, such as not containing ionizing radiation, being inexpensive, and being performed at the bedside. Recently, its use by anesthesiologists has become widespread in many lung pathologies, including atelectasis. Traditional and modified lung ultrasonography scoring systems can be used to evaluate atelectasis in lung parenchyma with ultrasonography. In addition to the traditional system, modified scoring system also enables to evaluate small subpleural consolidations In this study, it was aimed to compare the effects of volume controlled and pressure controlled ventilation modes used in general anesthesia in children on atelectasis with lung ultrasonography.

Conditions

Pulmonary Atelectasis; Mechanical Ventilation Complication; General Anesthesia; Lung Ultrasound

Keywords

Pulmonary Atelectasis; Mechanic Ventilation; General anesthesia; Lung Ultrasound

Outcome Measures

Primary Outcomes (1)

• Volume-controlled ventilation (VCV ) and pressure-controlled ventilation (PCV) respiratory ventilation modes modified lung ultrasonography scores before extubation

  Comparison of the total modified lung ultrasonography score of 12 quadrants (0-36 points) before extubation between groups in terms of atelectasis. An increase in the USG score indicates an increase in the severity of atelectasis. A decrease in the USG score indicates that the severity of atelectasis is low.

  Before extubation

Secondary Outcomes (5)

• Frequency of atelectasis in volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) respiratory ventilation modes

  Before LMA (preoperative period)

• Frequency of atelectasis in volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) respiratory ventilation modes

  10th minute after LMA

• Frequency of atelectasis in volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) respiratory ventilation modes

  10th minute after extubation

• Comparison of atelectasis incidence and modified Lung ultrasonography (USG) scores (0-3 points) in 12 different lung regions of patients followed in VCV/PCV ventilation modes under general anesthesia.

  pre-LMA period (preoperative period), 10th minute after LMA, pre-extubation period, 10th minute after extubation

• The effects of these ventilation modes on lung pressures parameters.

  10th minute after LMA, pre-extubation period

Study Arms (2)

Patients ventilated with volume controlled ventilation (VCV) mode

ACTIVE COMPARATOR

Patients to be ventilated with VCV mode were placed on respiratory support (Dräger Primus) with a breathing rate that would provide 8 ml/kg tidal volume, 5 cmH2O positive end expiratory pressure (PEEP), and 30-35 mmHg end-tidal carbon dioxide concentration (etCO2) level.

Procedure: Volume controlled ventilation (VCV) mode

Patients ventilated with pressure controlled ventilation (PCV) mode

ACTIVE COMPARATOR

Appropriate peak inspiratory pressure was set to create a tidal volume of 8 ml/kg in patients who would be ventilated with PCV mode. The number of breaths (Dräger Primus) was adjusted to provide an end-tidal carbon dioxide concentration (etCO2) level of 30-35 mmHg. PEEP was set to 5 cmH2O.

Procedure: Pressure controlled ventilation (PCV) mode

Interventions

Volume controlled ventilation (VCV) mode PROCEDURE

Patients to be ventilated with VCV mode were placed on respiratory support (Dräger Primus) with a breathing rate that would provide 8 ml/kg tidal volume, 5 cmH2O PEEP, and 30-35 mmHg end-tidal carbon dioxide concentration (etCO2) level. Lung ultrasonography was performed at 4 different time periods (before laryngeal mask airway (LMA), at the 10th minute after LMA, before extubation and at the 10th minute after extubation). Modified lung ultrasonography scores of 12 quadrants were recorded.

Patients ventilated with volume controlled ventilation (VCV) mode

Pressure controlled ventilation (PCV) mode PROCEDURE

Appropriate peak inspiratory pressure was set to create a tidal volume of 8 ml/kg in patients who would be ventilated with PCV mode. The number of breaths (Dräger Primus) was adjusted to provide an end-tidal carbon dioxide concentration (etCO2) level of 30-35 mmHg. PEEP was set to 5 cmH2O. Lung ultrasonography was performed at 4 different time periods (before laryngeal mask airway (LMA), at the 10th minute after LMA, before extubation and at the 10th minute after extubation). Modified lung ultrasonography scores of 12 quadrants were recorded.

Patients ventilated with pressure controlled ventilation (PCV) mode

Eligibility Criteria

• Age: 24 Months - 120 Months
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Aged between 2 and 10 years old
• American Society of Anesthesiologists (ASA) Scoring I-II
• Elective surgery planned
• Cases that will undergo general anesthesia
• Surgical time is expected to be \>30 minutes

You may not qualify if:

• Patients who are allergic to ultrasonography (USG) gel
• Known obstructive and restrictive lung disease
• Pulmonary infection in the last 3 months
• Having a history of surgery in the last 3 months
• A history of multiple trauma in the last 3 months
• Body Mass Index ≥30
• With diaphragmatic hernia
• Having undergone laparoscopic abdominal surgery

Sponsors & Collaborators

• Ankara Etlik City Hospital: lead

Study Sites (1)

Ahmet Aras

Yenimahalle, Ankara, 06170, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Pulmonary Atelectasis

Condition Hierarchy (Ancestors)

Lung Diseases; Respiratory Tract Diseases

Study Officials

• Ahmet Aras, MD

  Republic of Türkiye Ministry of Health Ankara Etlik City Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: DIAGNOSTIC
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: May 9, 2024
• First Posted: May 28, 2024
• Study Start: March 20, 2024
• Primary Completion: June 10, 2024
• Study Completion: June 25, 2024
• Last Updated: December 23, 2025

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)