Evaluation of the Effects of Intraoperative Ventilation Modes on Perioperative Atelectasis

NCT07413575 | Completed Results

• 1 other identifier: Ivstrh 2024/241
• Study Type: observational
• Target: 78
• Locations: 1 country
• Sites: 1

Brief Summary

In hysterectomy surgeries, due to factors such as the abdominal nature of the procedure, prolonged operative duration, and the use of the head-down (Trendelenburg) position during surgery, a lobe or a specific region of the lungs may collapse and fail to fill with air in the postoperative period. This condition is referred to as atelectasis. In this study, the investigators aimed to evaluate the effects of ventilation modes used in the operating room on the development of postoperative atelectasis using lung ultrasonography.

Conditions

Atelectasis, Postoperative Pulmonary

Keywords

Flow-Controlled Ventilation (FCV); Volume-Controlled Ventilation (VCV); Pressure-Controlled Ventilation (PCV); Perioperative atelectasis; Lung ultrasonography; mechanical power; oxygenation; lung ultrasound score

Outcome Measures

Primary Outcomes (1)

• Change in Lung Ultrasound Score (ΔLUS) From Preoperative Baseline to 24 Hours Postoperatively

  Perioperative atelectasis was assessed as the change in Lung Ultrasound Score (ΔLUS) from preoperative baseline to 24 hours postoperatively. Lung aeration was evaluated using a standardized 12-region scoring system (0-36 scores on a scale). ΔLUS was calculated as postoperative LUS at 24 hours minus preoperative baseline LUS. Higher values indicate greater loss of aeration.

  Preoperative baseline and 24 hours postoperatively

Secondary Outcomes (3)

• Mechanical Power During Intraoperative Ventilation

  Intraoperative period

• Arterial Oxygen Partial Pressure (PaO₂)

  Preoperative and at the time of transfer from the Post-Anesthesia Care Unit (PACU) to the ward (PACU discharge).

• PaO₂/FiO₂ Ratio

  Preoperative and at the time of transfer from the Post-Anesthesia Care Unit (PACU) to the ward (PACU discharge).

Other Outcomes (1)

• Change in Lung Ultrasound Score (ΔLUS) During Early Postoperative Period

  Preoperative baseline, at discharge from the Post-Anesthesia Care Unit (PACU), and at 2 hours postoperatively

Study Arms (3)

Flow-Controlled Ventilation (FCV)

Patients were divided into three groups according to the type of ventilation used. The group that received flow-controlled ventilation was designated as the FCV group. In the FCV group, a constant flow is applied during both inspiration and expiration. In all three groups, lung ultrasonographic evaluation was performed preoperatively and up to 24 hours postoperatively, and the lung ultrasound scores were determined. Vital signs, ventilation parameters, blood gas analysis, and pain scores were also recorded at specific time intervals.

Pressure-Controlled Ventilation (PCV)

Patients were divided into three groups according to the type of ventilation used. The group that received pressure-controlled ventilation was designated as the PCV group. In the PCV group, the peak airway pressure is controlled. The mandatory respiratory rate and inspiratory time are also adjusted. In all three groups, lung ultrasonographic evaluation was performed preoperatively and up to 24 hours postoperatively, and the lung ultrasound scores were determined. Vital signs, ventilation parameters, blood gas analysis, and pain scores were also recorded at specific time intervals.

Volume-Controlled Ventilation (VCV)

Patients were divided into three groups according to the ventilation mode used. The group receiving volume-controlled ventilation (VCV) was designated as the VCV group. In the VCV group, a specific tidal volume (Vt) was achieved by maintaining a constant flow rate and inspiratory time set on the ventilator, while airway pressure was allowed to vary. In all three groups, lung ultrasonographic evaluation was performed preoperatively and up to 24 hours postoperatively, and lung ultrasound scores were determined. Vital signs, ventilation parameters, blood gas analysis results, and pain scores were recorded at predefined time intervals.

Eligibility Criteria

• Age: 45 Years+
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients meet eligibility criteria and will undergone histerectomy surgery from 15/09/2024 to 15/09/2025 in Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital

You may qualify if:

• Patients aged 45 years and older scheduled for hysterectomy surgery with an expected operative duration of more than 2 hours
• Patients classified as American Society of Anesthesiologists (ASA) Physical Status Class I, II, or III
• Patients for whom planned total intravenous anesthesia was preferred

You may not qualify if:

• Patients younger than 45 years
• Patients planned for postoperative intensive care unit monitoring
• Patients unable to provide written informed consent
• Patients classified as American Society of Anesthesiologists Physical Status Class IV or higher
• Patients with a body mass index (BMI) greater than 35
• Patients who did not consent to participate in the study
• Patients with neuromuscular diseases
• Patients with uncontrolled asthma
• Patients with chronic obstructive pulmonary disease (COPD), Global Initiative for Chronic Obstructive Lung Disease (GOLD) Class IV
• Patients with scoliosis
• Patients with a history of pulmonary resection
• Patients with chest wall deformities
• Patients with a history of spontaneous pneumothorax
• Patients for whom inhalational anesthesia was preferred

Sponsors & Collaborators

• Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital: lead

Study Sites (1)

Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital

Sancaktepe, Istanbul, 34785, Turkey (Türkiye)

Location

Related Publications (11)

• Barnes T, van Asseldonk D, Enk D. Minimisation of dissipated energy in the airways during mechanical ventilation by using constant inspiratory and expiratory flows - Flow-controlled ventilation (FCV). Med Hypotheses. 2018 Dec;121:167-176. doi: 10.1016/j.mehy.2018.09.038. Epub 2018 Sep 24.

  PMID: 30396474 RESULT

• O'Gara B, Talmor D. Perioperative lung protective ventilation. BMJ. 2018 Sep 10;362:k3030. doi: 10.1136/bmj.k3030.

  PMID: 30201797 RESULT

• Beitler JR, Malhotra A, Thompson BT. Ventilator-induced Lung Injury. Clin Chest Med. 2016 Dec;37(4):633-646. doi: 10.1016/j.ccm.2016.07.004. Epub 2016 Oct 14.

  PMID: 27842744 RESULT

• Cressoni M, Gotti M, Chiurazzi C, Massari D, Algieri I, Amini M, Cammaroto A, Brioni M, Montaruli C, Nikolla K, Guanziroli M, Dondossola D, Gatti S, Valerio V, Vergani GL, Pugni P, Cadringher P, Gagliano N, Gattinoni L. Mechanical Power and Development of Ventilator-induced Lung Injury. Anesthesiology. 2016 May;124(5):1100-8. doi: 10.1097/ALN.0000000000001056.

  PMID: 26872367 RESULT

• Gertler R. Respiratory Mechanics. Anesthesiol Clin. 2021 Sep;39(3):415-440. doi: 10.1016/j.anclin.2021.04.003.

  PMID: 34392877 RESULT

• Gattinoni L, Pelosi P, Crotti S, Valenza F. Effects of positive end-expiratory pressure on regional distribution of tidal volume and recruitment in adult respiratory distress syndrome. Am J Respir Crit Care Med. 1995 Jun;151(6):1807-14. doi: 10.1164/ajrccm.151.6.7767524.

  PMID: 7767524 RESULT

• Protti A, Maraffi T, Milesi M, Votta E, Santini A, Pugni P, Andreis DT, Nicosia F, Zannin E, Gatti S, Vaira V, Ferrero S, Gattinoni L. Role of Strain Rate in the Pathogenesis of Ventilator-Induced Lung Edema. Crit Care Med. 2016 Sep;44(9):e838-45. doi: 10.1097/CCM.0000000000001718.

  PMID: 27054894 RESULT

• Mazo V, Sabate S, Canet J, Gallart L, de Abreu MG, Belda J, Langeron O, Hoeft A, Pelosi P. Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology. 2014 Aug;121(2):219-31. doi: 10.1097/ALN.0000000000000334.

  PMID: 24901240 RESULT

• Ball L, Hemmes SNT, Serpa Neto A, Bluth T, Canet J, Hiesmayr M, Hollmann MW, Mills GH, Vidal Melo MF, Putensen C, Schmid W, Severgnini P, Wrigge H, Gama de Abreu M, Schultz MJ, Pelosi P; LAS VEGAS investigators; PROVE Network; Clinical Trial Network of the European Society of Anaesthesiology. Intraoperative ventilation settings and their associations with postoperative pulmonary complications in obese patients. Br J Anaesth. 2018 Oct;121(4):899-908. doi: 10.1016/j.bja.2018.04.021. Epub 2018 Jun 2.

  PMID: 30236252 RESULT

• Duggan M, Kavanagh BP. Pulmonary atelectasis: a pathogenic perioperative entity. Anesthesiology. 2005 Apr;102(4):838-54. doi: 10.1097/00000542-200504000-00021.

  PMID: 15791115 RESULT

• Hedenstierna G, Edmark L. Mechanisms of atelectasis in the perioperative period. Best Pract Res Clin Anaesthesiol. 2010 Jun;24(2):157-69. doi: 10.1016/j.bpa.2009.12.002.

  PMID: 20608554 RESULT

MeSH Terms

Conditions

Pulmonary Atelectasis

Condition Hierarchy (Ancestors)

Lung Diseases; Respiratory Tract Diseases

Limitations and Caveats

The study was conducted at a single center and included only patients undergoing hysterectomy, which may limit generalizability. The observational design and lack of randomization prevent definitive conclusions about causal relationships between ventilation mode and perioperative atelectasis. Advanced hemodynamic and pulmonary monitoring methods were not used, and although computed tomography is the gold standard, lung ultrasonography was used.

Results Point of Contact

• Title: Dr. Tuğçe Türkan Tanman
• Organization: Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital, University of Health Sciences

tugce_alasirt@hotmail.com

+90 539 760 29 40

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 27, 2025
• First Posted: February 17, 2026
• Study Start: September 15, 2024
• Primary Completion: June 26, 2025
• Study Completion: August 5, 2025
• Last Updated: May 19, 2026
• Results First Posted: May 19, 2026

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)