From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea (SKP, HY, SY, WHK, YJL, JHB, JTK).
Eur J Anaesthesiol. 2021 Mar 1;38(3):275-284. doi: 10.1097/EJA.0000000000001435.
Pneumoperitoneum and steep Trendelenburg position promote the formation of pulmonary atelectasis during laparoscopic gynaecological surgery.
To determine whether lung ultrasound-guided alveolar recruitment manoeuvres could reduce peri-operative atelectasis compared with conventional recruitment manoeuvres during laparoscopic gynaecological surgery.
Randomised controlled trial.
Tertiary hospital, Republic of Korea, from August 2018 to January 2019.
Adult patients scheduled for laparoscopic gynaecological surgery under general anaesthesia.
Forty patients were randomised to receive either ultrasound-guided recruitment manoeuvres (manual inflation until no visibly collapsed area was seen with lung ultrasonography; intervention group) or conventional recruitment manoeuvres (single manual inflation with 30 cmH2O pressure; control group). Recruitment manoeuvres were performed 5 min after induction and at the end of surgery in both groups. All patients received volume-controlled ventilation with a tidal volume of 8 ml kg-1 and a positive end-expiratory pressure of 5 cmH2O.
The primary outcome was the lung ultrasound score at the end of surgery; a higher score indicates worse lung aeration.
Lung ultrasound scores at the end of surgery were significantly lower in the intervention group compared with control group (median [IQR], 7.5 [6.5 to 8.5] versus 9.5 [8.5 to 13.5]; difference, -2 [95% CI, -4.5 to -1]; P = 0.008). The intergroup difference persisted in the postanaesthesia care unit (7 [5 to 8.8] versus 10 [7.3 to 12.8]; difference, -3 [95% CI, -5.5 to -1.5]; P = 0.005). The incidence of atelectasis was lower in the intervention group compared with control group at the end of surgery (35 versus 80%; P = 0.010) but was comparable in the postanaesthesia care unit (40 versus 55%; P = 0.527).
The use of ultrasound-guided recruitment manoeuvres improves peri-operative lung aeration; these effects may persist in the postanaesthesia care unit. However, the long-term effects of ultrasound-guided recruitment manoeuvres on clinical outcomes should be the subject of future trials.
ClinicalTrials.gov (NCT03607240).
气腹和头高脚低位会促进腹腔镜妇科手术期间的肺不张形成。
确定与常规肺复张相比，在腹腔镜妇科手术期间，肺超声引导的肺泡复张术是否可以减少围手术期肺不张。
随机对照试验。
韩国一家三级医院，2018 年 8 月至 2019 年 1 月。
全麻下接受腹腔镜妇科手术的成年患者。
40 例患者随机分为超声引导复张组（手动充气，直至肺部超声检查未见明显塌陷区；干预组）或常规复张组（单次手动充气 30cmH2O 压力；对照组）。两组均在诱导后 5min 和手术结束时进行复张操作。所有患者均接受容量控制通气，潮气量 8ml/kg，呼气末正压 5cmH2O。
主要结局为手术结束时的肺部超声评分；评分越高，肺通气越差。
与对照组相比，干预组手术结束时的肺部超声评分显著降低（中位数[IQR]，7.5 [6.5 至 8.5] 比 9.5 [8.5 至 13.5]；差值-2[95%CI，-4.5 至-1]；P=0.008）。在麻醉后恢复室（7 [5 至 8.8] 比 10 [7.3 至 12.8]；差值-3[95%CI，-5.5 至-1.5]；P=0.005）中，组间差异仍存在。与对照组相比，干预组手术结束时的肺不张发生率较低（35 比 80%；P=0.010），但在麻醉后恢复室中相似（40 比 55%；P=0.527）。
使用超声引导的复张术可改善围手术期的肺通气；这些效果可能在麻醉后恢复室中持续存在。然而，超声引导的复张术对临床结局的长期影响应成为未来试验的主题。
ClinicalTrials.gov（NCT03607240）。
