Clinical Research Directory

Single-step vs Stepwise Lung Recruitment Maneuvers After Cardiopulmonary Bypass

This prospective randomized controlled trial aims to compare the hemodynamic and pulmonary effects of single-step and stepwise lung recruitment maneuvers in adult patients undergoing elective cardiac surgery with cardiopulmonary bypass. After separation from cardiopulmonary bypass, patients will be randomized to receive either a single-step sustained inflation recruitment maneuver or a stepwise incremental recruitment maneuver, both combined with 8 cmH₂O positive end-expiratory pressure. The primary outcome is the change in cardiac index before and after the recruitment maneuver. Secondary outcomes include lung ultrasound atelectasis score, and hemodynamic parameters.

Effects of Ultrasound-guided Recruitment Manoeuvres on Postoperative Pulmonary Complications in OSA Patients Undergoing Total Laparoscopic Hysterectomy

This study aims to evaluate the lung-protective effects of ultrasound-guided lung recruitment maneuvers in patients with OSA undergoing total laparoscopic hysterectomy and to explore the efficacy of EELV measurement in assessing the effectiveness of these maneuvers.

Dynamic Compliance-Guided Personalized PEEP During Laparoscopic Bariatric Surgery: Effects on Intraoperative Respiratory Parameters

Atelectasis may be encountered in the patient population aged 18-65 years undergoing elective laparoscopic bariatric surgery under general anesthesia with endotracheal intubation. The aim of this study is to compare oxygenation, postoperative atelectasis, and postoperative respiratory complications between the fixed PEEP application (SP Group) and personalized PEEP application (KP Group). In the SP Group, ventilation will be applied with PEEP = 8 cmH2O, tidal volume = 8 ml/kg, and respiratory rate to maintain EtCO2 between 35-40, and this ventilation mode was maintained throughout the entire surgery. In the KP Group, ventilation was applied with tidal volume = 8 ml/kg, PEEP = 4 cmH2O, and respiratory rate to maintain EtCO2 between 35 -40, and dynamic compliance was noted 1 minute after the onset of pneumoperitoneum at 12 mmHg. Subsequently, the PEEP value wastitrated every 2 minutes by increasing it by 2 cmH2O until the level providing the highest dynamic compliance value is reached. If the dynamic compliance value does not increase in two consecutive measurements, the previous PEEP value was defined as the patient's "personalized PEEP" value, and ventilation was continued with this PEEP value until the end of the surgery. In all patients, arterial blood gas (ABG) was obtained 10 minutes after anesthesia induction, at the 10th and 30th minutes of pneumoperitoneum, and 10 minutes after pneumoperitoneum is terminated.Patients were transferred to the recovery room after anesthesia is discontinued, and arterial blood gas sampling and lung ultrasound was performed at 30 minutes postoperatively. On postoperative day 1, presence of atelectasis was assessed with lung ultrasound, and SpO2 was recorded at 4th, 12th, and 24th hours postoperatively. Within 4 hours postoperatively, patients in need of supplemental oxygen were recorded(SpO2 92% was decided as cut-off value). After the 4th hour, the number of patients requiring supplemental oxygen after the 4th hour was recorded and compared in both groups. Data were collected and recorded using a standardized paper-based data collection form. A power analysis measurement (post-hoc test) is planned to be performed. If the power analysis exceeds 80% between the groups, the study will be terminated. Data collection was completed after reaching the planned number of volunteers. The study results will be evaluated using the SPSS statistical analysis program. Numerical data between groups (SP vs. KP) will be evaluated using the ANOVA test or Kruskal Wallis test, while categorical data will be evaluated using the chi-square test or Fisher exact test. P\<0.05 will be considered statistically significant, and univariate and multivariate analyses will be performed.

Ultrasound for Postop Lung Issues in Low-Flow Anesthesia

Detecting possible atelectasis and other respiratory problems that may develop immediately after extubation via lung ultrasonography can reduce pulmonary complications by performing necessary interventions such as oxygen support, respiratory exercises, mobilization, and non-invasive mechanical ventilation applications at an early stage. In addition, although low-flow anesthesia is frequently used in daily anesthesia practice, publications showing the effects of its use in laparoscopic cholecystectomy operations on pulmonary complications are limited. On this occasion, this study can be presented as a contribution to the literature.

Diaphragm Dysfunction and Ultrasound Perioperatively

This study aims at determining whether diaphragm ultrasound examining diaphragm thickening fraction, excursion and density before and after surgery can predict respiratory complications in the postoperative period. Patients scheduled for major elective abdominal, pelvic or vascular surgery will be included in the study and diaphragm ultrasound is performed before surgery and after surgery in the postoperative ward. Physiological parameters, laboratory parameters, data on surgery and anesthesia and comorbidities will be registered. Complications such as pneumonia, desaturation, need for intubation and other respiratory events up to 30 days will be registered and later correlated with the diaphragm measurements.

Physiological Effects and Safety of Continuous High-frequency Oscillatory Ventilation in ICU Patients

Atelectasis, hypoxemia, and ineffective sputum clearance are common problems in ICU patients. Continuous High-Frequency Oscillation (CHFO) is often considered to have a protective effect on the lungs. CHFO provides effective gas exchange at supraphysiological frequencies while minimizing pressure fluctuations, producing tidal volumes smaller than dead space, and adjusting around a continuously expanding pressure to optimize end-expiratory lung volume (EELV), thereby improving lung function by achieving and maintaining lung recruitment. However, the physiological effects and safety of CHFO in awake critically ill patients are still lacking relevant research. The objective of this study is to evaluate the comfort, safety, and efficacy of CHFO in awake critically ill patients.