From the Department of Anaesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China (CZ, SZ, JD, RW).
Eur J Anaesthesiol. 2021 Oct 1;38(10):1026-1033. doi: 10.1097/EJA.0000000000001451.
Atelectasis is a common postoperative complication. Peri-operative lung protection can reduce atelectasis; however, it is not clear whether this persists into the postoperative period.
To evaluate to what extent lung-protective ventilation reduces peri-operative atelectasis in children undergoing nonabdominal surgery.
Randomised, controlled, double-blind study.
Single tertiary hospital, 25 July 2019 to 18 January 2020.
A total of 60 patients aged 1 to 6 years, American Society of Anesthesiologists physical status 1 or 2, planned for nonabdominal surgery under general anaesthesia (≤2 h) with mechanical ventilation.
The patients were assigned randomly into either the lung-protective or zero end-expiratory pressure with no recruitment manoeuvres (control) group. Lung protection entailed 5 cmH2O positive end-expiratory pressure and recruitment manoeuvres every 30 min. Both groups received volume-controlled ventilation with a tidal volume of 6 ml kg-1 body weight. Lung ultrasound was conducted before anaesthesia induction, immediately after induction, surgery and tracheal extubation, and 15 min, 3 h, 12 h and 24 h after extubation.
The difference in lung ultrasound score between groups at each interval. A higher score indicates worse lung aeration.
Patients in the lung-protective group exhibited lower median [IQR] ultrasound scores compared with the control group immediately after surgery, 4 [4 to 5] vs. 8 [4 to 6], (95% confidence interval for the difference between group values -4 to -4, Z = -6.324) and after extubation 3 [3 to 4] vs. 4 [4 to 4], 95% CI -1 to 0, Z = -3.161. This did not persist from 15 min after extubation onwards. Lung aeration returned to normal in both groups 3 h after extubation.
The reduced atelectasis provided by lung-protective ventilation does not persist from 15 min after extubation onwards. Further studies are needed to determine if it yields better results in other types of surgery.
Chictr.org.cn (ChiCTR2000033469).
肺不张是一种常见的术后并发症。围手术期肺保护可减少肺不张；然而，其是否能持续到术后尚不清楚。
评估肺保护性通气在非腹部手术患儿中减少围手术期肺不张的程度。
随机、对照、双盲研究。
单中心三级医院，2019 年 7 月 25 日至 2020 年 1 月 18 日。
共纳入 60 例年龄 1 至 6 岁、美国麻醉医师协会身体状况 1 或 2 级、计划在全身麻醉下（≤2 h）行非腹部手术且需机械通气的患儿。
患儿随机分为肺保护性通气组或零呼气末正压（无复张手法）对照组。肺保护性通气采用 5 cmH2O 呼气末正压和每 30 min 进行复张手法。两组均采用容量控制通气，潮气量 6 ml/kg 体重。麻醉诱导前、诱导后、手术中、气管拔管时以及拔管后 15 min、3 h、12 h 和 24 h 行肺部超声检查。
两组在各时间点的肺部超声评分差异。评分越高，肺通气越差。
与对照组相比，肺保护性通气组患儿术后即刻、拔管即刻和拔管后 3 肺部超声评分较低，分别为 4 [4 至 5] 分比 8 [4 至 6] 分，（组间差值的 95%置信区间为-4 至-4，Z=-6.324）和 4 [3 至 4] 分比 8 [4 至 4] 分，95%CI-1 至 0，Z=-3.161。从拔管后 15 min 开始，这一差异不再存在。两组患儿在拔管后 3 h 时肺通气均恢复正常。
肺保护性通气减少的肺不张在拔管后 15 min 后不再持续。需要进一步研究以确定其在其他类型手术中是否能获得更好的结果。
Chictr.org.cn（ChiCTR2000033469）。
