Respiratory Tract (Lung and Bronchial) Diseases

All Conditions

Neoplasms

Blood and Lymph Conditions

Rare Diseases

Respiratory Insufficiency

Hematologic Neoplasms

Respiration Disorders

Respiratory Tract Diseases

Hematologic Diseases

Acute Graft Versus Host Disease

requiring mechanical ventilation at admission to ICU for one day or more during the study period

Mechanical ventilation

Dr.Enas A Abd El motlb, MD

This observational cohort aimed to re-evaluate the outcome of hematologic cancer patients admitted to the intensive care unit of Mansoura oncology center through a cohort study as regards their need for mechanical ventilation during two years.

It has been believed for many years that the scene of cancer patients requiring mechanical ventilation is frustrating. The needed life support measures drain much of health resources and add a significant burden on the patient's family. Many factors have been responsible for the high mortality rates among hematologic cancer patients admitted to intensive care unit. Among of these factors, the invasive treatments that are frequently employed in today's intensive care unit. These procedures give chance for development of severe infection and multiple organ failure which are common events in immune-compromised patients (e.g. neutropenia) and in those exposed to chemotherapy. The most common form of organ failure in those patients is acute respiratory failure which is a major predictor of mortality in that population. The prognosis of such failure may vary depending on its causes and severity, co morbidity, associated acute organ failure and characters of the underlying malignancy. After the recent advances in the field of intensive care and shedding light on the benefits of the noninvasive ventilation in immune-compromised patients, the overall survival rate of cancer patients admitted to intensive care unit are improving.

Prognosis of Hematological Cancer Patient Underwent Mechanical Ventillation

In a Developing Country; What is the Fate of Hematologic Cancer Patients Requiring Mechanical Ventilation for More Than One Day? A Prospective Cohort Study

Like as sepsis, acute respiratory distress syndorme, or leukopenia

Sequential Organ Failure Assessment (SOFA) Score

Simplified Acute Physiology Score (SAPS II)

synchronised intermittent, pressure-controlled, volume-controlled, pressure support, continuous positive airway pressure, volume guarantee, adjusted pressure release ventilation, or adaptive proportional assist ventilation

PaO2 "arterial oxygen tension"/FiO2 "inspired fraction of oxygen" ratio

Advanced malignancy, respiratory muscle weakness, respiratory failure, lung metastasis, coma, sepsis, multi-organs failure

Mansoura University

Assistant professor

Symptoms and General Pathology

Postoperative Complications

Lung Neoplasms

Respiratory Tract Neoplasms

Thoracic Neoplasms

Lung Diseases

mechanical ventilation with low tidal volume (5 ml/kg of ideal body weight) plus PEEP

tidal volume of 10 ml/kg of ideal body weight without PEEP

mechanical ventilation

tidal volume

Emmanuel Marret, MD

The purpose of this trial is to evaluate the efficacy and the safety of lung protective ventilation during anesthesia in patients undergoing pneumonectomy or lobectomy for lung cancer.

Extended description of the protocol could be provided by the URC-EST, SAINT ANTOINE HOSPITAL, University of Paris-VI and by principal investigator.

Pneumonectomy or lobectomy is associated with a high risk for postoperative complication. The benefit of lung protective ventilation with low tidal volume has been demonstrated in patients with acute respiratory distress syndrome (ARDS) and acute lung injury (ALI). Recent clinical studies have suggested that mechanical ventilation with low tidal volume may also profit in others setting. Lung protective ventilation during anaesthesia has been found to limit the inflammatory response in the lung and to decrease postoperative systemic inflammatory response. However, others trials did not found benefit of protective ventilation strategy during anaesthesia.

This study will be a randomized, controlled, doubled blind trial comparing two management ventilator strategies during anaesthesia for thoracotomy. Only patients undergoing pneumonectomy or lobectomy for lung primitive cancer will be included in this trial. During anesthesia, one group will receive mechanical ventilation with low tidal volume (5 ml/kg of ideal body weight) plus PEEP and the other will receive tidal volume of 10 ml/kg of ideal body weight without PEEP. After surgery, data concerning oxygen delivery, blood analysis, complications, cancer recurrence and death will be collected.

Pulmonary Surgery and Protective Mechanical Ventilation

Assistance Publique - Hôpitaux de Paris

Urinary Tract, Sexual Organs, and Pregnancy Conditions

Digestive System Diseases

Carcinoma, Renal Cell

Pneumoperitoneum

Kidney Neoplasms

Carcinoma

Urologic Neoplasms

Urogenital Neoplasms

Urogenital Diseases

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

Kidney Diseases

Urologic Diseases

Male Urogenital Diseases

Adenocarcinoma

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Renal Cell Carcinoma

Central Nervous System Depressants

All Drugs and Chemicals

Anesthetics

patients in whom the standard trocar will be used to perform robot-assisted complex partial nephrectomy surgery

patients in whom the valveless trocar will be used to perform robot-assisted complex partial nephrectomy surgery

the valveless trocar will be used instead of the standard trocar - these trocars are used for insufflation of carbon dioxide into the abdomen

valveless trocar

standard trocar, usually camera port for robotic surgery

standard trocar

Ester Forastiere, MD

Maria Sofra, MD

Marco Covotta, MD

The goal of this clinical trial is to compare two kind of trocar in patients undergoing complex robot-assisted partial nephrectomy. The main question it intends to answer is whether the use of valveless trocars can significantly reduce carbon dioxide absorption.

In the literature there are studies on the benefit of valveless trocars in robotic surgery. There are no studies on the potential effects even in complex kidney surgery. Through this randomized study we want to investigate whether the ability to clear CO2 is better using valveless trocars

control arm: patients in which traditional laparoscopic trocar is used intervention arm: patients in which the valveless trocar is used

Valveless Trocar Versus Standard Trocar in Robot-assisted Complex Partial Nephrectomy

Perioperative Effects of Valveless Trocar Versus Standard Trocar in Robot-assisted Complex Partial Nephrectomy: a Randomized Prospective Study

Regina Elena Cancer Institute

E Forastiere, MD, Head of Anestesiology and Intensive care Unit

Immune System Diseases

Diseases and Abnormalities at or Before Birth

Lymphoma

Leukemia

Syndrome

Respiratory Distress Syndrome

Respiratory Distress Syndrome, Newborn

Lymphosarcoma

Respiratory Distress Syndrome, Infant

Acute Respiratory Distress Syndrome

Dimercaprol

Chelating Agents

Fiberoptic bronchoscopy and bronchoalveolar lavage

Elie Azoulay, MD,PhD

The MiniMax® study is a multicenter randomized controlled study aimed at demonstrating that a combination of non-invasive diagnostic tools are as effective as fiberoptic bronchoscopy and bronchoalveolar lavage (FO-BAL) in performing the etiological diagnosis of acute respiratory failure in cancer patients.

Acute respiratory failure is a dreadful complication in cancer patients. Indeed, about 20% of the patients will present with pulmonary infiltrates, but Intensive Care Unit (ICU) admission and mechanical ventilation will be needed in half of them resulting in mortality for most of the patients. Managing cancer patients with respiratory failure implicates three mandatory tasks: 1) early antibiotics administration covering suspected pathogens; 2) search for the actual aetiology; and 3) adequate supportive care with access to invasive or non invasive respiratory support. Performing the etiological diagnosis is crucial. Fiberoptic bronchoscopy and bronchoalveolar lavage (FO-BAL) remains the cornerstone of the management of pulmonary infiltrates in cancer patients. However, non-invasive diagnostic tools have been validated in the recent years. Diagnostic and therapeutic impacts of FO-BAL are only of 30% to 60% and 15% to 60% respectively. In neutropenic patients and recipients of bone marrow or stem cell transplantation, this impact is significantly altered. Moreover, reports have highlighted significant rates of complications such as haemorrhage (5%), respiratory deterioration (11% to 40%), possibly heading to intubation and subsequent death. Therefore, balancing advantages to risks of FO-BAL is in order. The MiniMax® study is a multicenter randomized controlled study aimed at demonstrating that a combination of non-invasive diagnostic tools are as effective as FO-BAL in performing the etiological diagnosis of acute respiratory failure in cancer patients. In addition, these non-invasive tests might not lead to deterioration of the respiratory status and corresponding requirement to intubation and mechanical ventilation. The group of investigators is used to manage cancer patients with pulmonary involvement. In the 21 centres, patients will be randomized to be managed either with FO-BAL or with only non-invasive tools. In each case, patients will be managed with the best supportive care including adequate antibiotics, respiratory support and all needed life sustaining therapies. Our hypothesis is to reduce intubation rate using a non-invasive approach (without FO-LBA). Surrogate markers will be hospital mortality and the number of diagnostic procedures in each group of patients.

Réa-MiniMax: Severe Acute Respiratory Failure in Hematology and Cancer Patients Without Bronchoalveolar Lavage

Severe Acute Respiratory Failure in Hematology and Cancer Patients Without Bronchoalveolar Lavage. A Multicentric Randomized Controlled Trial

Saliha DJANE

Esophageal Neoplasms

Lymphoproliferative Disorders

Lymphatic Diseases

Immunoproliferative Disorders

Esophageal Cancer

Different settings of CPAP and BiPAP will be tested using a home mechanical ventilator

CPAP

Robin Wijsman

J. Elshof

When using highly conformal radiotherapy techniques, such as proton therapy, a controlled breathing pattern and a minimal breathing amplitude could greatly benefit the treatment of mobile tumors. This reduction in tumor motion may be achieved with the use of a ventilator that is able to regulate and modulate the breathing pattern. CPAP provides a constant level of positive airway pressure. Compared to spontaneous breathing, the use of CPAP increased lung volume and can result in a significant decrease in tumor movement and a significant decrease in both mean lung and mean heart radiation dose. These results were found in patients treated for limited stage disease, it is not clear if this approach is feasible for patients with more advanced stage of disease that undergo radiotherapy with curative intent.

With Bilevel Positive Airway Pressure (BiPAP), tidal volume excursions are determined by the pressure difference between the set inspiratory positive airway pressure (IPAP) and the set expiratory positive airway pressure (EPAP). This mode of ventilation increases lung volume comparable to CPAP, but also to control tidal volumes and breathing frequency. However, BiPAP has never been studied in the setting of motion mitigation during radiotherapy and BiPAP might be more difficult to adjust to for patients compared to CPAP. Therefore, the current study is proposed to evaluate whether or not CPAP or BiPAP is of benefit in patients that undergo radiotherapy for larger intra-thoracic tumor volumes.

The study will follow a 2-step approach.

First (Phase 1, n=10), the feasibility of short-term use of CPAP and BiPAP and its effects on (regional) lung volumes, tidal volumes and breathing frequency will be investigated in patients with intra-thoracic tumors who are planned for radiotherapy. This is necessary to select the best setting of CPAP or BiPAP with which minimal tumor motion is expected (and that is feasible for the patient).

In the second phase (n=21), the particular setting found in fase 1 is investigated: weekly repeated radiotherapy planning (4D) CT scans with and without CPAP/BiPAP will be aquired to evaluate the influence on tumor motion and dose to the target and organs at risk. Radiotherapy will be deliverd according to local protocol without the use of CPAP/BiPAP.

CPAP or BiPAP for Motion Mitigation During Radiotherapy

Continuous and Bi-level Positive Airway Pressure for Motion Mitigation of Intra-thoracic Tumors Treated With Radiotherapy

The primary objective is to evaluate the lung volume changes (in cm3) induced by the use of mechanical ventilation

Feasibility is expressed as a score (using a Visual Analoge Scale)

Feasibility is expressed as the duration (minutes) the participant can undergo mechanical ventilation

University Medical Center Groningen

Principal Investigator

Gland and Hormone Related Diseases

Skin and Connective Tissue Diseases

Leiomyoma

Ovarian Neoplasms

Carcinoma, Ovarian Epithelial

Uterine Cervical Neoplasms

Myofibroma

Cholecystitis

Acalculous Cholecystitis

Cysts

Ovarian Cysts

Myoma

Ovarian Diseases

Adnexal Diseases

Genital Diseases, Female

Genital Diseases

Endocrine System Diseases

Gonadal Disorders

Gallbladder Diseases

Biliary Tract Diseases

Gastrointestinal Diseases

Neoplasms, Connective and Soft Tissue

Neoplasms, Connective Tissue

Connective Tissue Diseases

Ovarian Cancer

Ovarian Epithelial Cancer

Analgesics

Other Dietary Supplements

Remifentanil

Desflurane

Benzocaine

Analgesics, Opioid

Narcotics

Anesthetics, Inhalation

Anesthetics, General

Tannic Acid

Drug: Desflurane Anesthesia with desflurane in both Group 1 and Group 2 - adjust minimum alveolar concentration (MAC) to maintain bispectral index (BIS) between 40-60

Drug: Remifentanil Adjuvant continuous administration

- adjust effect site concentration to maintain changes of vital sign below 20%

Device: Ultrasonographic measurement of ONSD

Procedure/Surgery: Mechanical ventilation Maintain the end-tidal carbon dioxide partial pressure between 35 and 40 mmHg and peak inspiratory pressure below 30 cmH2O.

Trendelenburg position - 30 degree

Drug: Desflurane Anesthesia with desflurane in both Group 1 and Group 2 - adjust MAC to maintain BIS between 40-60

Drug: Remifentanil Adjuvant continuous administration

- adjust effect site concentration to maintain changes of vital sign below 20%

Device: Ultrasonographic measurement of ONSD

Procedure/Surgery: Mechanical ventilation Maintain the end-tidal carbon dioxide partial pressure between 35 and 40 mmHg and peak inspiratory pressure below 30 cmH2O.

Reverse Trendelenburg position - 30 degree

Anesthesia with desflurane in both Group 1 and Group 2

- adjust MAC to maintain BIS between 40-60

Adjuvant continuous administration

- adjust effect site concentration to maintain changes of vital sign below 20%

Patients were placed in the supine position with their eyes closed, and a thick gel layer was applied to the closed upper eyelid. The 7.5-MHz linear probe was placed on the gel without excessive pressure and adjusted to the proper angle for displaying the entry of the optic nerve into the globe. The intensity of the ultrasound was adjusted to display optimal contrast between the retrobulbar echogenic fat tissue and the vertical hypoechoic band. An ultrasound beam was focused on the retrobulbar area (4 cm deep) using the lowest possible acoustic power that could measure ONSD. The ONSD was measured 3 mm behind the optic disc. Measurements were performed in the transverse and sagittal planes of both eyes, and the final ONSD value was calculated by averaging 4 measured values.

Ultrasonographic measurement of ONSD

After tracheal intubation, the lungs of the patients were then ventilated with oxygen in air (1:2) using a tidal volume of 8-10 mL/kg and a respiratory rate of 10-12/min, and the ventilation rate was adjusted to maintain the end-tidal carbon dioxide partial pressure between 35 and 40 mmHg and peak inspiratory pressure below 30 cmH2O.

Trendelenburg position - 30 degree

Reverse Trendelenburg position - 30 degree

Ki Tae Jung, M.D.

Increase of intracerebral pressure (ICP) during laparoscopic surgery has known to be associated with positional changes. Optic nerve sheath diameter (ONSD) has correlation with ICP and ultrasonographic measurement of optic nerve sheath diameter (ONSD) is known to be a noninvasive and rapidly applicable technique for evaluating ICP. The aim of this study is to investigate the change of ONSD according to the positional change during laparoscopic surgery.

1. Purpose There can be many physiologic changes during laparoscopic surgery. Increase of intracerebral pressure (ICP) is one of them, which has known to be associated with arterial concentration of carbon dioxide or positional changes. Changes of ICP can be measured directly by invasive method. However, optic nerve sheath diameter (ONSD) has correlation with ICP and ultrasonographic measurement of optic nerve sheath diameter (ONSD) is known to be a noninvasive and rapidly applicable technique for evaluating ICP. The aim of this study is to investigate the change of ONSD according to the positional change during laparoscopic surgery.
2. Hypothesis Changes of ONSD will be shown according to the positional change during laparoscopic surgery, and these can reflect the changes of ICP.
3. Objectives Female patients who are scheduled to undergo laparoscopic surgery, American society of anesthesiologist class (ASA) I-II, aged between 19 to 65 years, are allocated into 2 groups.

   * Group 1: Laparoscopic gynecological surgery, (Trendelenburg position)
   * Group 2: Laparoscopic cholecystectomy, (Reverse trendelenburg position)
4. Methods Patients are premedicated with midazolam 0.5 mg/kg before transported to the operating room. Once in the operating room, patients were monitored with electrocardiography, non invasive blood pressure, pulse oximetry (Datex-Ohmeda S/5, Planar Systems, Inc., Beaverton, OR, USA) and BIS (Aspect 2000, Aspect Medical Systems, Inc., Newton, MA, USA).

   Anesthesia are induced with propofol (2mg/kg) and followed by administering rocuronium 0.6 mg/kg. After tracheal intubation, the lungs of the patients were then ventilated with oxygen in air (1:2) using a tidal volume of 8-10 mL/kg and a respiratory rate of 10-12/min, and the ventilation rate was adjusted to maintain the end-tidal carbon dioxide partial pressure between 35 and 40 mmHg and peak inspiratory pressure below 30 cmH2O. Anesthesia is maintained with desflurane in addition to the continuous infusion of remifentanil. Radial arterial cannulation is done for invasive arterial blood pressure monitoring.

   After induction of anesthesia, when stabilization of cardiovascular status is achieved, optic nerve sheath diameter (ONSD) is measured by ultrasonographic measurement. Patients were placed in the supine position with their eyes closed, and a thick gel layer was applied to the closed upper eyelid. The 7.5-MHz linear probe was placed on the gel without excessive pressure and adjusted to the proper angle for displaying the entry of the optic nerve into the globe. The intensity of the ultrasound was adjusted to display optimal contrast between the retrobulbar echogenic fat tissue and the vertical hypoechoic band. An ultrasound beam was focused on the retrobulbar area (4 cm deep) using the lowest possible acoustic power that could measure ONSD. The ONSD was measured 3 mm behind the optic disc. Measurements were performed in the transverse and sagittal planes of both eyes, and the final ONSD value was calculated by averaging 4 measured values.

   ONSD was measured at 7 serial time points during surgery:
   1. Preinduction (prior to the induction of anesthesia in the operating room)
   2. 5 minutes after induction of anesthesia
   3. 5 minutes after introducing pneumoperitoneum
   4. 5 minutes after positional change
   5. 15 minutes after positional change
   6. 30 minutes after positional change
   7. 5 minutes after discontinuing pneumoperitoneum Arterial blood gas analysis is performed to evaluate the arterial carbon dioxide concentration (PaCO2) level at each time point.
5. Statistical Analysis All data are expressed as numbers (%) or mean ± standard deviation. Repeated measures ANOVA will be performed to compare the parameters at specific time points during surgery.

ONSD According to the Position During Laparoscopy

Comparison of Optic Nerve Sheath Diameter According to Position During Laparoscopy

ONSD - preinduction (prior to the induction of anesthesia in the operating room)

ONSD and PaCO2 - 5 minutes after induction of anesthesia

ONSD and PaCO2 - 15 min after positional change

ONSD and PaCO2 - 30 minutes after positional change

ONSD and PaCO2 - 5 minutes after discontinuing pneumoperitoneum

ONSD and PaCO2 - 5 minutes after introducing positional change

ONSD and PaCO2 - 5 minutes after introducing pneumoperitoneum

Chosun University Hospital

Assist professor

Infections

Critical Illness

Shock

Shock, Septic

Neutropenia

Disease Attributes

Granulocytopenia

Elie Azoulay, MD, PhD

The purpose of this study is to determine:

* Condition of intensive care unit (ICU) admission in patients with haematological malignancies.
* ICU hospital and up to one year mortality.
* Assessment of post ICU burden and health related quality at 90-d and 1 year.

1. To identify prognostic factors of short and medium term mortality, by underlining the respective weights of organ dysfunction and characteristics of underlined malignancy
2. Evaluate the health related quality of life of intensive care survivors(SF36)
3. Impact of intensive care on families burden (HADS, IES).
4. Assess clinicians' satisfaction ( intensivists, haematologists and intensive care nurses) in relation to medical decision-making.
5. Establish the relevance of antifungal treatments.

The Use of Intensive Care in Critically Ill Cancer Haematological Patients: "TRIAL-OH"

Long Term Outcomes in Critically Ill Haematological Patients. The Use of Intensive Care in Critically Ill Cancer Haematological Patients

survival status (alive or death) at one year

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Prognosis of Hematological Cancer Patient Underwent Mechanical Ventillation	NCT02562105	Hematological M... Acute Respirato... Mechanical Vent...	Mechanical vent...	18 Years - 75 Years	Mansoura University
Pulmonary Surgery and Protective Mechanical Ventilation	NCT00805077	Lung Neoplasms	mechanical vent... tidal volume	18 Years - 90 Years	Assistance Publique - Hôpitaux de Paris
Valveless Trocar Versus Standard Trocar in Robot-assisted Complex Partial Nephrectomy	NCT05732857	Cancer of Kidne...	valveless troca... standard trocar	18 Years -	Regina Elena Cancer Institute
Réa-MiniMax: Severe Acute Respiratory Failure in Hematology and Cancer Patients Without Bronchoalveolar Lavage	NCT00248443	Lymphoma Cancer Acute Respirato... Leukemia	Fiberoptic bron...	18 Years -	Assistance Publique - Hôpitaux de Paris
CPAP or BiPAP for Motion Mitigation During Radiotherapy	NCT04986293	Radiotherapy Si... NSCLC Esophageal Canc... Malignant Lymph...	CPAP	18 Years -	University Medical Center Groningen
ONSD According to the Position During Laparoscopy	NCT01937104	Cholecystitis Ovarian Cyst Ovarian Cancer Uterine Myoma Cervical Cancer	Desflurane Remifentanil Ultrasonographi... Mechanical vent... Trendelenburg p... Reverse Trendel...	19 Years - 65 Years	Chosun University Hospital
Réa-MiniMax: Severe Acute Respiratory Failure in Hematology and Cancer Patients Without Bronchoalveolar Lavage	NCT00248443	Lymphoma Cancer Acute Respirato... Leukemia	Fiberoptic bron...	18 Years -	Assistance Publique - Hôpitaux de Paris
Prognosis of Hematological Cancer Patient Underwent Mechanical Ventillation	NCT02562105	Hematological M... Acute Respirato... Mechanical Vent...	Mechanical vent...	18 Years - 75 Years	Mansoura University
The Use of Intensive Care in Critically Ill Cancer Haematological Patients: "TRIAL-OH"	NCT01172132	Hematological M...		18 Years -	Assistance Publique - Hôpitaux de Paris
ONSD According to the Position During Laparoscopy	NCT01937104	Cholecystitis Ovarian Cyst Ovarian Cancer Uterine Myoma Cervical Cancer	Desflurane Remifentanil Ultrasonographi... Mechanical vent... Trendelenburg p... Reverse Trendel...	19 Years - 65 Years	Chosun University Hospital

Spots Global Cancer Trial Database for mechanical ventilation