Feasibility of postural lung recruitment maneuver in children: a randomized, controlled study

Abstract

Background: Pulmonary atelectasis in anesthetized children is easily reverted by lung recruitment maneuvers. However, the high airways pressure reached during the maneuver could negatively affect hemodynamics. The aim of this study is to assess the effect and feasibility of a postural lung recruitment maneuver (P-RM); i.e., a new maneuver that opens up the atelectatic lung areas based on changing the child's body position under constant ventilation with moderated driving pressure (12 cmH 2 O) and of positive end-expiratory pressure (PEEP, 10 cmH 2 O). Forty ASA I-II children, aged 6 months to 7 years, subjected to general anesthesia were studied. Patients were ventilated with volume control mode using standard settings with 5 cmH 2 O of PEEP. They were randomized into two groups: (1) control group (C group, n = 20)-ventilation was turned to pressure control ventilation using a fixed driving pressure of 12 cmH 2 O. PEEP was increased from 5 to 10 cmH 2 O during 3 min maintaining the supine position. (2) P-RM group (n = 20)-patients received the same increase in driving pressure and PEEP, but they were placed, respectively, in the left lateral position, in the right lateral position (90 s each), and back again into the supine position after 3 min. Then, ventilation returned to baseline settings in volume control mode. Lung ultrasound-derived aeration score and respiratory compliance were assessed before (T1) and after (T2) 10 cmH 2 O of PEEP was applied. Results: At baseline ventilation (T1), both groups showed similar aeration score (P-RM group 9.9 ± 1.9 vs C group 10.4 ± 1.9; p = 0.463) and respiratory compliance (P-RM group 15 ± 6 vs C group 14 ± 6 mL/cmH 2 O; p = 0.517). At T2, the aeration score decreased in the P-RM group (1.5 ± 1.6 vs 9.9 ± 2.1; p < 0.001), but remained without changes in the C group (9.9 ± 2.1; p = 0.221). Compliance was higher in the P-RM group (18 ± 6 mL/cmH 2 O) when compared with the C group (14 ± 5 mL/cmH 2 O; p = 0.001). Conclusion: Lung aeration and compliance improved only in the group in which a posture change strategy was applied.

Identifying and Understanding Risk Factors for Instability and Adverse Events Associated With Chest Physiotherapy in Ventilated Children

“…Morrow et al (2007) reported no differences between recruitment manoeuvre or control groups, either immediately or at 25 minutes postintervention. Similar findings have been reported by Acosta et al (2020). This in the control group.…”

Identifying and Understanding Risk Factors for Instability and Adverse Events Associated With Chest Physiotherapy in Ventilated Children

“…Morrow et al (2007) reported no differences between recruitment manoeuvre or control groups, either immediately or at 25 minutes postintervention. Similar findings have been reported by Acosta et al (2020). This in the control group.…”

Targeted Lateral Positioning Decreases Lung Collapse and Overdistension in COVID-19-Associated ARDS

“…This is the rst description of using EIT with targeted lateral positioning to personalize PEEP in adult patients with COVID-19-associated ARDS. A randomized and controlled trial demonstrated the feasibility and e cacy of a postural recruitment maneuver in children with anesthesia-induced atelectasis [7]. Besides being applied in children with healthy lungs, another difference between the Acosta et al and our study is the lack of PEEP titrations.…”

“…Very recently, Zhao et al reported the use of EIT for individualized ventilation strategy in one patient with COVID-19 [8]. Similarly to the study in children with anesthesia-induced atelectasis [7], a key difference between the Zhao et al case report and our case series is the lack of a strategy to personalize PEEP during the lateral positioning.…”

Targeted lateral positioning decreases lung collapse and overdistension in COVID-19-associated ARDS

“…Very recently, Zhao et al reported the use of EIT for individualized ventilation strategy in one patient with COVID-19 [ 11 ]. Similarly to the study in children with anesthesia-induced atelectasis [ 10 ], a key difference between the Zhao et al case report and our case series is the lack of a strategy to personalize PEEP during the lateral positioning.…”

Identifying and Understanding Risk Factors for Instability and Adverse Events Associated With Chest Physiotherapy in Ventilated Children

“…Morrow et al (2007) reported no differences between recruitment manoeuvre or control groups, either immediately or at 25 minutes postintervention. Similar findings have been reported by Acosta et al (2020). This in the control group.…”

Targeted Lateral Positioning Decreases Lung Collapse and Overdistension in COVID-19-Associated ARDS

“…This is the rst description of using EIT with targeted lateral positioning to personalize PEEP in adult patients with COVID-19-associated ARDS. A randomized and controlled trial demonstrated the feasibility and e cacy of a postural recruitment maneuver in children with anesthesia-induced atelectasis [7]. Besides being applied in children with healthy lungs, another difference between the Acosta et al and our study is the lack of PEEP titrations.…”

“…Very recently, Zhao et al reported the use of EIT for individualized ventilation strategy in one patient with COVID-19 [8]. Similarly to the study in children with anesthesia-induced atelectasis [7], a key difference between the Zhao et al case report and our case series is the lack of a strategy to personalize PEEP during the lateral positioning.…”

Targeted lateral positioning decreases lung collapse and overdistension in COVID-19-associated ARDS

“…Very recently, Zhao et al reported the use of EIT for individualized ventilation strategy in one patient with COVID-19 [ 11 ]. Similarly to the study in children with anesthesia-induced atelectasis [ 10 ], a key difference between the Zhao et al case report and our case series is the lack of a strategy to personalize PEEP during the lateral positioning.…”

Identifying and Understanding Risk Factors for Instability and Adverse Events Associated With Chest Physiotherapy in Ventilated Children

“…Morrow et al (2007) reported no differences between recruitment manoeuvre or control groups, either immediately or at 25 minutes postintervention. Similar findings have been reported by Acosta et al (2020). This in the control group.…”

Targeted Lateral Positioning Decreases Lung Collapse and Overdistension in COVID-19-Associated ARDS

“…This is the rst description of using EIT with targeted lateral positioning to personalize PEEP in adult patients with COVID-19-associated ARDS. A randomized and controlled trial demonstrated the feasibility and e cacy of a postural recruitment maneuver in children with anesthesia-induced atelectasis [7]. Besides being applied in children with healthy lungs, another difference between the Acosta et al and our study is the lack of PEEP titrations.…”

“…Very recently, Zhao et al reported the use of EIT for individualized ventilation strategy in one patient with COVID-19 [8]. Similarly to the study in children with anesthesia-induced atelectasis [7], a key difference between the Zhao et al case report and our case series is the lack of a strategy to personalize PEEP during the lateral positioning.…”

Targeted lateral positioning decreases lung collapse and overdistension in COVID-19-associated ARDS

“…Very recently, Zhao et al reported the use of EIT for individualized ventilation strategy in one patient with COVID-19 [ 11 ]. Similarly to the study in children with anesthesia-induced atelectasis [ 10 ], a key difference between the Zhao et al case report and our case series is the lack of a strategy to personalize PEEP during the lateral positioning.…”