最佳呼气末正压通气预防婴幼儿麻醉诱导性肺不张：一项前瞻性、随机、双盲试验。

Optimal positive end-expiratory pressure to prevent anaesthesia-induced atelectasis in infants: A prospective, randomised, double-blind trial.

机构信息

From the Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.

出版信息

Eur J Anaesthesiol. 2021 Oct 1;38(10):1019-1025. doi: 10.1097/EJA.0000000000001483.

DOI:10.1097/EJA.0000000000001483

PMID:33720065

Abstract

BACKGROUND

Paediatric patients have a particularly high incidence of anaesthesia-induced atelectasis. Applying positive end-expiratory pressure (PEEP) with an alveolar recruitment manoeuvre has been substantially studied and adopted in adults; however, few studies have been conducted in children.

OBJECTIVE

We compared the effects of three levels of PEEP (3, 6 and 9 cmH2O) on anaesthesia-induced atelectasis measured by ultrasound in infants between 6 and 12 months of age who were undergoing general anaesthesia.

DESIGN

A prospective, randomised, double-blind trial.

SETTING

Department of Anaesthesia, single centre, South Korea, from May 2019 to March 2020.

PATIENTS

Children who were 6 to 12 months of age, whose American Society of Anesthesiologists (ASA) physical status was 1 or 2, whose height and weight were within two standard deviations of those of their peers, and who were scheduled for elective urological or general surgery were included in the study.

MAIN OUTCOME MEASURES

The primary outcome was the lung ultrasound score at the end of the procedure. The secondary outcomes included dynamic compliance, peak inspiratory pressure, driving pressure, cardiac index, mean arterial pressure and heart rate before and after applying PEEP.

RESULTS

The mean lung ultrasound score at the end of operation was 12.8 at PEEP 6 cmH2O and 12.1 at PEEP 9 cmH2O. Both were significantly lower than 18.4 at PEEP 3 cmH2O (P = 0.0002 and 0.00003, respectively). However, there was no significant difference between the scores of PEEP 6 cmH2O and PEEP 9 cmH2O. The Δ cardiac index (the cardiac index after PEEP - the cardiac index at 3 cmH2O of PEEP) was comparable among the three groups.

CONCLUSION

To reduce anaesthesia-induced atelectasis measured by ultrasound in healthy infants undergoing low abdominal, genitourinary or superficial regional operations, 6 cmH2O of PEEP was more effective than 3 cmH2O. PEEP of 9 cmH2O was comparable with 6 cmH2O.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT03969173.

摘要

背景

小儿患者麻醉后肺不张的发生率特别高。在成人中，应用呼气末正压通气（PEEP）联合肺泡复张手法已得到大量研究和应用；然而，在儿童中进行的研究较少。

目的

我们比较了三种 PEEP 水平（3、6 和 9cmH2O）对 6-12 个月大、行全身麻醉的婴幼儿麻醉后肺不张的影响，通过超声进行测量。

设计

前瞻性、随机、双盲试验。

地点

韩国某单一中心麻醉科，于 2019 年 5 月至 2020 年 3 月进行。

患者

纳入标准为 6-12 个月大、美国麻醉医师协会（ASA）身体状况为 1 或 2 级、身高和体重均在其同龄人的两个标准差范围内、择期行泌尿外科或普外科手术的患儿。

主要观察指标

主要结局指标为手术结束时的肺超声评分。次要结局指标包括：动态顺应性、吸气峰压、驱动压、心指数、平均动脉压和心率，分别在应用 PEEP 前后进行测量。

结果

PEEP 为 6cmH2O 时，手术结束时的平均肺超声评分（12.8）和 PEEP 为 9cmH2O 时（12.1）均显著低于 PEEP 为 3cmH2O 时（18.4）（P=0.0002 和 0.00003）。然而，PEEP 为 6cmH2O 与 PEEP 为 9cmH2O 时的评分无显著差异。三组间的 Δ心指数（PEEP 后的心指数-PEEP 为 3cmH2O 时的心指数）无显著差异。