Clinical Research Directory

Preoperative Nutritional Status and Postoperative Outcomes in Geriatric Lung Resection

Malnutrition is a common comorbidity in patients undergoing thoracic surgery. Furthermore, chronic diseases, polypharmacy, low nutrient intake, reduced appetite, and psychological factors-all frequently observed in geriatric patients-serve as risk factors for the development of nutritional deficiencies. Consequently, it is crucial to address the issue of malnutrition in geriatric patients-who often present with these risk factors-and to ensure that a nutritional status assessment is performed prior to thoracic surgery. While numerous screening tools are currently available to assess nutritional status in the elderly, there is no established "gold standard." Although it has been suggested that these nutritional screening tools can serve as prognostic indicators for geriatric surgical patients, the relationship between these tools and postoperative outcomes-such as pain, complications, and length of hospital stay-has not yet been fully evaluated in geriatric patients undergoing lung resection. This study aims to determine the relationship between preoperative nutritional status and postoperative outcomes in patients undergoing lung resection-an area lacking sufficient literature-and to investigate whether preoperative nutritional support can reduce postoperative complications in this patient population.Patients will undergo preoperative assessment, and data regarding those meeting inclusion criteria will be recorded. This includes routine blood tests, age, height, body weight, BMI, gender, diagnoses, ASA and ARISCAT scores, the surgery performed, durations of surgery/anesthesia/one-lung ventilation, intraoperative fluids and IV agents administered, fluid balance, any complications arising during the procedure or postoperative follow-up (up to discharge), Visual Analog Scale (VAS) scores at postoperative hours 1, 2, 4, 8, 16, and 24, Charlson Comorbidity Index, Clinical Frailty Scale (CFS), and nutritional status (GNRI, NRS-2002, PNI, MNA-SF). * Inclusion criteria: Patients undergoing elective thoracic surgery; patients undergoing lung resection via thoracotomy; patients who have provided informed consent; patients over 65 years of age; patients assessed as ASA class 1, 2, or 3; patients with a body mass index (BMI) between 18 and 35. * Exclusion criteria: Patients with ASA class IV or higher; patients scheduled for emergency surgery; patients under 65 years of age; patients with a history of prior thoracic surgery; patients in GOLD groups 3 or 4; patients with systemic inflammatory disease; patients with preoperative chronic pain who regularly use anti-inflammatories/analgesics; patients with a history of pulmonary thromboembolism (PTE).

Preoperative Pneumococcal and Influenza Vaccination to Prevent Postoperative Pulmonary Infection in Patients Undergoing Lung Resection for Pulmonary Nodules or Lung Cancer

Postoperative pneumonia (POP) affects 4%-24% of lung cancer surgery patients, increasing mortality, stay, costs and worsening prognosis, especially in older patients. Perioperative immunosuppression and synergistic influenza/pneumococcal infection support perioperative vaccination, which may also induce trained immunity; thoracic surgery data are lacking. This multicenter, prospective, randomized, open-label, blinded-endpoint (PROBE) trial will enroll \~1278 patients aged ≥50 undergoing anatomical lung resection for pulmonary nodules or lung cancer, randomized 1:1 to vaccination or no vaccination, with 180-day follow-up. Randomization uses a computer-generated, site-stratified block sequence, concealed via central IWRS or sealed envelopes. An unblinded team handles screening, randomization and vaccination data; surgeons and assessors are blinded. No site may exceed 50% of enrollment. Vaccination group receives 23-valent pneumococcal polysaccharide and quadrivalent influenza vaccines intramuscularly in separate arms 14-28 days preoperatively. Controls receive no vaccine/placebo, with surgery scheduled 14-28 days after randomization. Concomitant indicated treatments are permitted and recorded. Primary endpoint is POP per modified CDC/NHSN criteria: new/progressive imaging infiltrate (excluding atelectasis, edema, embolism, tumor), plus ≥1 clinical sign (fever \>38 °C, WBC ≤4000 or ≥12,000/mm³, or altered mental status if ≥70 years) and ≥2 respiratory signs. Findings on days 3-5 are excluded unless persistent/worsening. Microbiology is confirmatory, not required.

AirGo™ Respiratory Monitoring in Lung Resection

Patients undergoing lung resection surgery may experience changes in respiratory function during the perioperative period. Current monitoring methods provide important clinical information but are often limited to specific time points and may not allow continuous assessment of ventilation. This study aims to evaluate the feasibility and usefulness of the AirGo™ wearable respiratory monitoring system in patients undergoing anatomical lung resection (lobectomy or segmentectomy). AirGo™ is a non-invasive, CE-marked device that continuously measures respiratory parameters, including minute ventilation and respiratory rate, through a chest-worn sensor. Participants will wear the AirGo™ device before surgery and during the postoperative period. Respiratory parameters collected by AirGo™ will be analyzed at predefined time points and compared with standard clinical monitoring methods routinely used in postoperative care, including pulse oximetry and telemetry. The primary objective is to assess changes in mean minute ventilation from the preoperative period to the first postoperative day. Secondary objectives include evaluating perioperative respiratory trends, patient comfort and compliance with the device, and the agreement between AirGo™ measurements and standard monitoring systems. The results of this study may help determine whether continuous non-invasive respiratory monitoring can improve the assessment and management of patients undergoing lung surgery.

Effect of Individualized Positive End-expiratory Pressure (PEEP) in Patients Who Have an Intrinsic PEEP During One-lung Ventilation

This study investigates the effects of three extrinsic PEEP settings-5 cmH2O, 0 cmH2O, and an individualized PEEP (70% of the measured intrinsic PEEP)-on intrinsic PEEP and hemodynamic stability in patients with intrinsic PEEP undergoing lung resection surgery, using a randomized, crossover design.

Lung Ultrasound to Assess Aeration Loss After Lung Resection Surgery

The purpose of this prospective observational study is to assess perioperative changes in lung aeration after lung resection surgery using lung ultrasound, and to explore their relationship with oxygenation, inflammatory biomarkers, cardiac stress markers and diaphragmatic function.

Effect of Oxygen Administration in the Non-dependent Lung on Postoperative Complications After Lung Surgery

The purpose of this study is to analyze the effectiveness of apneic oxygenation and CPAP applied to the non-dependent lung during pulmonary resection surgery in reducing inflammatory response, ischemia-reperfusion injury, and postoperative complications. We will conduct a randomized, controlled, and blinded study in 177 patients with three arms: * Control Group: Oxygen therapy according to standard clinical practice * Apneic oxygenation group: A probe will be introduced through the lumen of the double-lumen tube (DLT) to administer a continuous source of oxygen without any mechanism that generates airway pressure. * CPAP Group: Continuous positive airway pressure with 3-5 L/min oxygen flow and 2 cm H2O pressure delivered via a Mapleson system. Inflammatory mediators in blood and in both lungs will be measured intraoperatively and 24 hours after surgery. Patients will be followed from hospital admission until discharge and again 30 days after surgery to evaluate the postoperative course, particularly the occurrence of complications according to the revised Clavien-Dindo classification for thoracic surgery, as well as other relevant clinical outcomes.