Comparison of Hemodynamic Effects of Two Modalities of Alveolar Recruitment Maneuvers in Major Abdominal Surgery Patients (CHARM-Bloc)
Cardiac Output, Decreased Cardiac Output, Hemodynamic Monitoring
About this trial
This is an interventional other trial for Cardiac Output focused on measuring mechanical ventilation,, hemodynamics,, ARM,, CPAP,, extended sigh,, cardiac output
Eligibility Criteria
Inclusion Criteria:
- patient over 18 years old
- patient under general anesthesia
- patient intubated under controlled invasive mechanical ventilation
- patient with invasive hemodynamic monitoring (transpulmonary thermodilution)
- patient sedated (BIS between 40 and 60) and/or curarized with TOF monitoring to avoid inspiratory effort
- patient optimized on the hemodynamic level, in particular with regard to blood volume, following the hemodynamic monitoring data and the recommendations of the French Society of Anesthesia and Resuscitation (RFE SFAR 2013 - Perioperative vascular filling strategy)
- patient covered by a Social Security plan
- patient consent to participate in the study
Exclusion Criteria:
- contraindication to the use of cardiac output measurement
- cardiac arrhythmia
- pace-maker/implantable defibrillator
- severe valvulopathy
- contraindication to the use of the tomographic electroimpedancemetry technique
- thoracic lesions, thoracic dressing
- left ventricular ejection fraction (LVEF) < 45% and/or right ventricular failure.
- history of pulmonary lobectomy and/or pneumonectomy and/or known emphysema
- patient with restrictive or obstructive lung disease
- body mass index (BMI) < 16.5 or > 30 kg.m-2
- pregnancy
- intracranial hypertension or suspected intracranial hypertension
- patient under limitation of care
- patient under legal protection (guardianship, curatorship, safeguard of justice)
Sites / Locations
- CHU
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Continuous positive airway pressure (CPAP) then extended sigh
extended sigh then continuous positive airway pressure (CPAP)
Patients assigned to this group will receive a CPAP ARM (40cmH2O during 50 seconds), followed by a 10-minute pause corresponding to a period of return to basal state. Then an ARM by extended sigh (e-sigh) also 50 seconds (driving pressure at 10cmH2O and successive PEEP levels at 10, 15, 20, 25 and 30cmH2O, with respiratory frequency fixed at 30/min in controlled pressure). Hemodynamic (blood pressure, cardiac output, stroke volume) and ventilatory measurements will be performed the last 10 seconds of each recruitment maneuver.
Patients assigned to this group will receive an ARM by extended sigh (e-sigh) during 50 seconds (driving pressure at 10cmH2O and successive PEEP levels at 10, 15, 20, 25 and 30cmH2O, with respiratory frequency fixed at 30/min in controlled pressure), followed by a 10-minute pause corresponding to a period of return to basal state. Then they receive a CPAP ARM (40cmH2O during 50 seconds). Hemodynamic (blood pressure, cardiac output, stroke volume) and ventilatory measurements will be performed the last 10 seconds of each recruitment maneuver.