Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Br J Anaesth. 2020 May;124(5):648-655. doi: 10.1016/j.bja.2020.01.022. Epub 2020 Mar 10.
Desaturation frequently occurs in infants after general anaesthesia in the prone position. We aimed to evaluate the effect of regular alveolar recruitment in preventing atelectasis in infants and children after general anaesthesia in the prone position.
Children (<3 yr) undergoing general anaesthesia (>2 h) in the prone position were randomised to either receive regular alveolar recruitment or standardised care without recruitment. Ultrasound-guided alveolar recruitment was performed for both groups, and mechanical ventilation was started with a tidal volume of 6 ml kg and PEEP of 7 cm HO. During mechanical ventilation, the intervention (regular recruitment) group received alveolar recruitment once per hour. Lung ultrasound was performed after inducing anaesthesia and each position change. The primary outcome was the incidence of significant atelectasis (defined by consolidation score ≥2 in any region) before extubation, as evaluated by lung ultrasound undertaken by an investigator masked to trial allocation.
Seventy-three children (regular recruitment: 37; standardised care: 36) were included in the analysis. Before the hourly intervention, atelectasis was similar between children randomised to regular alveolar recruitment or standardised care in both supine (83.3%, both groups; P>0.99) and prone positions (88.9% vs 91.9%; P=0.970). The incidence of atelectasis before extubation was lower in children receiving regular alveolar recruitment (8.1%), compared with 47.2% in children randomised to standardised care (absolute risk reduction: 39.1% [95% confidence interval: 20.6-57.6%); P<0.001).
Regular alveolar recruitment reduced the incidence of atelectasis at the end of surgery in infants and children <3 yr undergoing general anaesthesia in the prone position.
NCT03486847.
全身麻醉后婴儿俯卧位常发生低氧血症。我们旨在评估常规肺泡复张对预防全身麻醉后俯卧位婴儿和儿童肺不张的效果。
接受全身麻醉（>2 小时）且处于俯卧位的儿童（<3 岁）被随机分为接受常规肺泡复张或不进行复张的标准治疗。两组均进行超声引导下的肺泡复张，机械通气采用 6ml/kg 的潮气量和 7cmH2O 的 PEEP。在机械通气过程中，干预（常规复张）组每小时进行一次肺泡复张。在诱导麻醉后和每次体位改变后进行肺部超声检查。主要结局是通过对试验分配盲法评估的肺部超声评估拔管前的显著肺不张（任何区域的实变评分≥2）发生率。
73 名儿童（常规复张组 37 名；标准治疗组 36 名）纳入分析。在每小时干预之前，常规肺泡复张或标准治疗的儿童在仰卧位（83.3%，两组；P>0.99）和俯卧位（88.9%比 91.9%；P=0.970）的肺不张发生率相似。接受常规肺泡复张的儿童拔管前肺不张发生率较低（8.1%），而接受标准治疗的儿童发生率为 47.2%（绝对风险降低：39.1%[95%置信区间：20.6-57.6%]；P<0.001）。
常规肺泡复张降低了全身麻醉下俯卧位婴儿和儿童（<3 岁）手术结束时肺不张的发生率。
NCT03486847。
