Effect of an ultrasound-guided lung recruitment manoeuvre on postoperative atelectasis in children

Lee, Ji‐Hyun; Choi, Seung-Myung; Ji, Sang‐Hwan; Jang, Young‐Eun; Kim, Eun‐Hee; Kim, Hee‐Soo; Kim, Jin‐Tae

doi:10.1097/eja.0000000000001175

Cited by 31 publications

(46 citation statements)

References 25 publications

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“…Lastly, the de nition of substantial atelectasis was not validated by previous studies. Although previous studies have used lung ultrasound as a diagnostic tool for atelectasis (15,19,21,(29)(30)(31), the criteria for substantial atelectasis are yet to be established.…”

Section: Discussionmentioning

confidence: 99%

Lung ultrasound score to determine the effect of fraction inspired oxygen during alveolar recruitment on absorption atelectasis in laparoscopic surgery: A randomized controlled trial

Kim

Lee

Bae

et al. 2020

Preprint

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Background: Although the intraoperative alveolar recruitment maneuver (RM) efficiently treats atelectasis, the effect of Fio2 on atelectasis during RM is uncertain. We hypothesized that a high Fio2 (1.0) during RM would lead to a higher degree of postoperative atelectasis without benefiting oxygenation when compared to low Fio2 (0.4). Methods: In this randomized controlled trial, patients undergoing elective laparoscopic surgery in the Trendelenburg position were allocated to low- (Fio2 0.4, n=44) and high-Fio2 (Fio2 1.0, n=46) groups. RM was performed 1-min post tracheal intubation and post changes in supine and Trendelenburg positions during surgery. We set the intraoperative Fio2 at 0.4 for both groups and calculated the modified lung ultrasound score (LUSS) to assess lung aeration after anesthesia induction and at surgery completion. The primary outcome was modified LUSS at the end of the surgery. The secondary outcomes were the intra- and postoperative Pao2 to Fio2 ratio and postoperative pulmonary complications. Results: The modified LUSS before capnoperitoneum and RM (P=0.747) were similar in both groups. However, the postoperative modified LUSS was significantly lower in the low Fio2 group (median difference 5.0, 95% CI 3.0‒7.0, P<0.001). Postoperatively, substantial atelectasis was more common in the high-Fio2 group (relative risk 1.77, 95% CI 1.27‒2.47, P<0.001). Intra- and postoperative Pao2 to Fio2 were similar with no postoperative pulmonary complications. Atelectasis occurred more frequently when RM was performed with high than with low Fio2; oxygenation was not benefitted by a high-Fio2.Conclusions: In patients undergoing laparoscopic surgery in the Trendelenburg position, absorption atelectasis occurred more frequently with high rather than low Fio2. No oxygenation benefit was observed in the high-Fio2 group. Trial registration: ClinicalTrials.gov, NCT03943433. Registered 7 May 2019, https://clinicaltrials.gov/ct2/show/NCT03943433

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Section: Discussionmentioning

confidence: 99%

Lung ultrasound score to determine the effect of fraction inspired oxygen during alveolar recruitment on absorption atelectasis in laparoscopic surgery: A randomized controlled trial

Kim

Lee

Bae

et al. 2020

Preprint

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“…In paediatrics, lung-protective ventilation has been proved useful in improving oxygenation 17 as well as reducing the incidence of anaesthesia-induced atelectasis. 18 – 20 However, its beneficial effects on postoperative atelectasis remain unclear. 20 …”

Section: Introductionmentioning

confidence: 99%

Effects of positive end-expiratory pressure/recruitment manoeuvres compared with zero end-expiratory pressure on atelectasis in children

Zhu

Zhang²,

Jun-li³

et al. 2021

European Journal of Anaesthesiology

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BACKGROUND Atelectasis is a common postoperative complication. Peri-operative lung protection can reduce atelectasis; however, it is not clear whether this persists into the postoperative period. OBJECTIVE To evaluate to what extent lung-protective ventilation reduces peri-operative atelectasis in children undergoing nonabdominal surgery. DESIGN Randomised, controlled, double-blind study. SETTING Single tertiary hospital, 25 July 2019 to 18 January 2020. PATIENTS A total of 60 patients aged 1 to 6 years, American Society of Anesthesiologists physical status 1 or 2, planned for nonabdominal surgery under general anaesthesia (≤2 h) with mechanical ventilation. INTERVENTIONS The patients were assigned randomly into either the lung-protective or zero end-expiratory pressure with no recruitment manoeuvres (control) group. Lung protection entailed 5 cmH 2 O positive end-expiratory pressure and recruitment manoeuvres every 30 min. Both groups received volume-controlled ventilation with a tidal volume of 6 ml kg −1 body weight. Lung ultrasound was conducted before anaesthesia induction, immediately after induction, surgery and tracheal extubation, and 15 min, 3 h, 12 h and 24 h after extubation. MAIN OUTCOME MEASURES The difference in lung ultrasound score between groups at each interval. A higher score indicates worse lung aeration. RESULTS Patients in the lung-protective group exhibited lower median [IQR] ultrasound scores compared with the control group immediately after surgery, 4 [4 to 5] vs. 8 [4 to 6], (95% confidence interval for the difference between group values −4 to −4, Z = -6.324) and after extubation 3 [3 to 4] vs. 4 [4 to 4], 95% CI −1 to 0, Z = −3.161. This did not persist from 15 min after extubation onwards. Lung aeration returned to normal in both groups 3 h after extubation. CONCLUSIONS The reduced atelectasis provided by lung-protective ventilation does not persist from 15 min after extubation onwards. Further studies are needed to determine if it yields better results in other types of surgery. TRIAL REGISTRATION Chictr.org.cn (ChiCTR2000033469).

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“…Lastly, the definition of substantial atelectasis was not validated by previous studies. Although previous studies have used lung ultrasound as a diagnostic tool for atelectasis [15,19,21,[29][30][31], the criteria for substantial atelectasis are yet to be established.…”

Section: Discussionmentioning

confidence: 99%

Lung ultrasound score to determine the effect of fraction inspired oxygen during alveolar recruitment on absorption atelectasis in laparoscopic surgery: a randomized controlled trial

et al. 2020

View full text Add to dashboard Cite

Background: Although the intraoperative alveolar recruitment maneuver (RM) efficiently treats atelectasis, the effect of FIO 2 on atelectasis during RM is uncertain. We hypothesized that a high FIO 2 (1.0) during RM would lead to a higher degree of postoperative atelectasis without benefiting oxygenation when compared to low FIO 2 (0.4). Methods: In this randomized controlled trial, patients undergoing elective laparoscopic surgery in the Trendelenburg position were allocated to low-(FIO 2 0.4, n = 44) and high-FIO 2 (FIO 2 1.0, n = 46) groups. RM was performed 1-min post tracheal intubation and post changes in supine and Trendelenburg positions during surgery. We set the intraoperative FIO 2 at 0.4 for both groups and calculated the modified lung ultrasound score (LUSS) to assess lung aeration after anesthesia induction and at surgery completion. The primary outcome was modified LUSS at the end of the surgery. The secondary outcomes were the intra-and postoperative PaO 2 to FIO 2 ratio and postoperative pulmonary complications. Results: The modified LUSS before capnoperitoneum and RM (P = 0.747) were similar in both groups. However, the postoperative modified LUSS was significantly lower in the low FIO 2 group (median difference 5.0, 95% CI 3.0-7.0, P < 0.001). Postoperatively, substantial atelectasis was more common in the high-FIO 2 group (relative risk 1.77, 95% CI 1.27-2.47, P < 0.001). Intra-and postoperative PaO 2 to FIO 2 were similar with no postoperative pulmonary complications. Atelectasis occurred more frequently when RM was performed with high than with low FIO 2 ; oxygenation was not benefitted by a high-FIO 2. Conclusions: In patients undergoing laparoscopic surgery in the Trendelenburg position, absorption atelectasis occurred more frequently with high rather than low FIO 2. No oxygenation benefit was observed in the high-FIO 2 group.

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Effect of an ultrasound-guided lung recruitment manoeuvre on postoperative atelectasis in children

Cited by 31 publications

References 25 publications

Lung ultrasound score to determine the effect of fraction inspired oxygen during alveolar recruitment on absorption atelectasis in laparoscopic surgery: A randomized controlled trial

Lung ultrasound score to determine the effect of fraction inspired oxygen during alveolar recruitment on absorption atelectasis in laparoscopic surgery: A randomized controlled trial

Effects of positive end-expiratory pressure/recruitment manoeuvres compared with zero end-expiratory pressure on atelectasis in children

Lung ultrasound score to determine the effect of fraction inspired oxygen during alveolar recruitment on absorption atelectasis in laparoscopic surgery: a randomized controlled trial

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