Air Test In Diagnosis Of Postoperative Lung Atelectasis
Keywords
Abstract
Description
Although it has been postulated that early hypoxemia lasts approximately two hours after a surgical procedure, the first 20 minutes of the postoperative period seem to be most critical . It is evident that the majority of transport times would fall well within this 20 minute window , thus the potential for postoperative hypoxemia during the transport period does exist. Canet, et al. (1989) found significant differences in oxygen saturation when administering 35% oxygen to adults in the PACU after a 30 second transport while breathing room air.The alveolar shunt induced by atelectasis is the main cause of oxygenation impairment during postoperative period. Witting MD, Lueck CH reported the ability of pulse oximetry at room air to detect hypoxemia based on 513 blood gas analysis. Coincidentially a room air oxygen saturation value <96% was selected a cut point of hypoxemia ( Po2 <70 mmhg )and moderate hypercapnia ( Pco2 >50 mmhg ) . Jones and Jones descriped a digram showing relationship between SPO2 and FiO2 and proved that SPO2 < 96% correspond to shunt effect of more than 10% and defines alveolar collapse . clark et al 2001determined time required for partial pressure of arterial oxygen to reach equilibrium during mechanical ventilation after a step change in fractional inspired oxygen, they reported that 5-10 minutes will be adequate . Ferrando C 2017 reported The accuracy of postoperative, non-invasive Air-Test to diagnose atelectasis in healthy patients after surgery They found that the air test diagnosed postoperative atelectasis with sensitivity of 82% and specificity of 87% and area uder the curve of 0.9 The presence of atelectasis was confirmed by CT scan in all patients with positive air test and in 5 patients with negative air test .The Air-Test may represent an accurate, simple, inexpensive and non-invasive method for diagnosing postoperative atelectasis.Sonography is a simple, noninvasive, and radiation-free methodology which has gained increasing usage in daily practice for detection of atelectasis. Sonography is a radiation-free methodology which plays an important role in diagnosing pulmonary diseases including obstructive and compressive atelectasis of different origins Furthermore, lung ultrasound has shown reliable sensitivity and specificity for the diagnosis of anaesthesia-induced atelectasis . Telectasis after general anaesthesia is basal and segmental. For this,we designed this trial as a pilot to detect the accuracy (sensitivity and specificity) of Air-Test to detect atelectasis in a homogenous group (elderly patients undergoing orthopedic surgery) using Roc testing.
Dates
| Last Verified: | 06/30/2020 |
| First Submitted: | 06/30/2020 |
| Estimated Enrollment Submitted: | 06/30/2020 |
| First Posted: | 07/06/2020 |
| Last Update Submitted: | 06/30/2020 |
| Last Update Posted: | 07/06/2020 |
| Actual Study Start Date: | 09/30/2020 |
| Estimated Primary Completion Date: | 10/31/2021 |
| Estimated Study Completion Date: | 01/31/2022 |
Condition or disease
Intervention/treatment
Diagnostic Test: Air Test
Phase
Arm Groups
| Arm | Intervention/treatment |
|---|---|
| Active Comparator: positive air test Before induction patients received supplemental oxygen through a venture mask with a jet and flow adjusted to a theoretical fio2 of 100% for 10 min. The Air-Test was then performed by removing the oxygen mask and leaving the patients breathing room air for 10 min while continuously monitoring SpO2 with a pulse oximeter finger probe. The Air-Test result was considered positive when the recorded SpO2 was ≤96%.The same test will be done postoperatively in the recovery room. | |
| Active Comparator: negative air test negative when SpO2 was >96 %. |
Eligibility Criteria
| Ages Eligible for Study | 60 Years To 60 Years |
| Sexes Eligible for Study | All |
| Accepts Healthy Volunteers | Yes |
| Criteria | Inclusion Criteria: - - Age (>60 years) - ASA I , III - Type of surgery: major orthopedic surgey Exclusion Criteria: - -Patient refusal. - Patients with any significant chest disease - Patients with any major cardiac disese - Morbid obese |
Outcome
Primary Outcome Measures
1. to assess the accuracy of air test in detecting postoperative atelectasis compared with reference ultrasonographic lung detection of atelectasis in a special grou of patients (aged) and a special form of surgery (orthopedics). [30 minutes]
