Ji Sang-Hwan, Jang Hwan Suk, Jang Young-Eun, Kim Eun-Hee, Lee Ji-Hyun, Kim Jin-Tae, Kim Hee-Soo
From the Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital (S-HJ, HSJ, Y-EJ, E-HK, J-HL, J-TK, H-SK) and Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea (J-TK, H-SK).
Eur J Anaesthesiol. 2020 Dec;37(12):1150-1156. doi: 10.1097/EJA.0000000000001327.
Atelectasis occurs commonly during induction of general anaesthesia in children, particularly infants.
We hypothesised that maintaining spontaneous ventilation can reduce atelectasis formation during anaesthetic induction in infants. We compared spontaneous ventilation and manual positive-pressure ventilation in terms of atelectasis formation in infants.
Randomised controlled study.
Single tertiary hospital in Seoul, Republic of Korea, from November 2018 to December 2019.
We enrolled 60 children younger than 1 year of age undergoing general anaesthesia, of whom 56 completed the study. Exclusion criteria were history of hypoxaemia during previous general anaesthesia, development of a respiratory tract infection within 1 month, current intubation or tracheostomy cannulation, need for rapid sequence intubation, preterm birth, age within 60 weeks of the postconceptional age and the presence of contraindications for rocuronium or sodium thiopental.
Patients were allocated randomly to either the 'spontaneous' group or 'controlled' group. During preoxygenation, spontaneous ventilation was maintained in the 'spontaneous' group while conventional bag-mask ventilation was provided in the 'controlled' group. After 5 min of preoxygenation, a lung ultrasound examination was performed to compare atelectasis formation in the two groups.
Atelectasis after preoxygenation was seen in seven (26.9%) of 26 patients in the 'spontaneous' group and 22 (73.3%) of 30 patients in the 'controlled' group (P = 0.001). The relative risk of atelectasis in the 'spontaneous' group was 0.39 (95% CI 0.211 to 0.723). Regarding ultrasound pictures of consolidation, the total score and sum of scores in the dependent regions were significantly lower in the 'spontaneous' group than in the 'controlled' group (P = 0.007 and 0.001, respectively).
Maintaining spontaneous ventilation during induction of general anaesthesia has a preventive effect against atelectasis in infants younger than 1 year of age, particularly in the dependent portions of the lungs.
Clinicaltrials.gov (identifier: NCT03739697).
肺不张在儿童全身麻醉诱导期间很常见，尤其是婴儿。
我们假设维持自主通气可减少婴儿麻醉诱导期间肺不张的形成。我们比较了自主通气和人工正压通气在婴儿肺不张形成方面的情况。
随机对照研究。
2018年11月至2019年12月期间韩国首尔的一家三级医院。
我们纳入了60名接受全身麻醉的1岁以下儿童，其中56名完成了研究。排除标准包括既往全身麻醉期间有低氧血症病史、1个月内发生呼吸道感染、目前正在进行气管插管或气管切开插管、需要快速顺序插管、早产、孕龄后60周内、以及存在罗库溴铵或硫喷妥钠的禁忌证。
将患者随机分配到“自主通气”组或“控制”组。在预给氧期间，“自主通气”组维持自主通气，而“控制”组进行传统的面罩通气。预给氧5分钟后，进行肺部超声检查以比较两组肺不张的形成情况。
“自主通气”组26例患者中有7例（26.9%）在预给氧后出现肺不张，“控制”组30例患者中有22例（73.3%）出现肺不张（P = 0.001）。“自主通气”组肺不张的相对风险为0.39（95%CI 0.211至0.723）。关于实变的超声图像，“自主通气”组相关区域的总分和分数总和显著低于“控制”组（分别为P = 0.007和0.001）。
全身麻醉诱导期间维持自主通气对1岁以下婴儿的肺不张有预防作用，尤其是在肺的下垂部位。
Clinicaltrials.gov（标识符：NCT03739697）。
