Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Diagnostic imaging Center, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Pediatr Crit Care Med. 2019 May;20(5):442-449. doi: 10.1097/PCC.0000000000001865.
Lung ultrasound can reliably diagnose pulmonary atelectasis. The object of this study is to determine the most efficient region to assess changes in atelectasis in children with congenital heart disease under general anesthesia.
Randomized controlled trial.
Operating room at university-affiliated children's hospital.
Children between 3 months and 3 years old, scheduled for elective congenital heart disease surgery under general anesthesia.
Forty children with congenital heart disease were randomly allocated to either a 5 cm H2O positive end-expiratory pressure group or a standard therapy control group.
Preoperative lung ultrasound was performed twice in each patient-after 1 and 15 minutes of mechanical ventilation. Atelectatic areas and B-lines were compared between two examinations. Different ultrasound regions were evaluated using Bland-Altman plots. The occurrence rate of atelectasis was much higher in inferoposterior lung regions (Scans 4-6) than in anterior and lateral regions (Scans 1-3). The median (interquartile range) lung ultrasound scores were lower in the positive end-expiratory pressure group than in the control group after treatment: 8 (3.3-9.8) versus 13 (8.3-17.5; p < 0.001). The atelectatic area was significantly decreased after treatment in the positive end-expiratory pressure group: 128 mm (34.5.5-213.3 mm) versus 49.5 mm (5.3-75.5 mm; p < 0.001). Bland-Altman plots revealed concordance between measurements in Scans 1-6 and those in Scans 4-6. In the posterior axillary line regions, changes in atelectatic area were significantly larger in the positive end-expiratory pressure group than in the control group (p = 0.03, 0.007, and 0.018).
Lung ultrasound in inferoposterior lung regions may be more likely to reflect changes in atelectasis and save examination time; 5 cm H2O positive end-expiratory pressure may be useful in lung reaeration and can reduce, but not eliminate, atelectasis in children with congenital heart disease.
肺部超声能够可靠地诊断肺不张。本研究的目的是确定在全身麻醉下患有先天性心脏病的儿童中评估肺不张变化的最有效区域。
随机对照试验。
大学附属儿童医院手术室。
3 个月至 3 岁之间，计划在全身麻醉下接受择期先天性心脏病手术的儿童。
40 名患有先天性心脏病的儿童被随机分配到 5cmH2O 呼气末正压组或标准治疗对照组。
每位患者在机械通气后 1 分钟和 15 分钟进行两次术前肺部超声检查。比较两次检查之间的不张区域和 B 线。使用 Bland-Altman 图评估不同的超声区域。下后肺区（扫描 4-6）的不张发生率明显高于前外侧肺区（扫描 1-3）。与对照组相比，正压呼气末组的肺部超声评分中位数（四分位距）治疗后降低：8（3.3-9.8）与 13（8.3-17.5；p<0.001）。正压呼气末组治疗后不张面积明显减小：128mm（34.5.5-213.3mm）与 49.5mm（5.3-75.5mm；p<0.001）。Bland-Altman 图显示扫描 1-6 与扫描 4-6 的测量值之间具有一致性。在后腋线区域，正压呼气末组的不张面积变化明显大于对照组（p=0.03、0.007 和 0.018）。
下后肺区的肺部超声可能更能反映不张的变化并节省检查时间；5cmH2O 的呼气末正压可能有助于肺复张，并可减少，但不能消除，先天性心脏病患儿的肺不张。
