Department of Anesthesiology, Intensive Care and Pain Management, Ain Shams University Faculty of Medicine, Cairo, Egypt.
Paediatr Anaesth. 2024 Apr;34(4):332-339. doi: 10.1111/pan.14836. Epub 2024 Jan 8.
Maintaining oxygenation during neonatal open repair of esophageal atresia/tracheoesophageal fistula is difficult. Inverse ratio ventilation can be used during one lung ventilation to improve the oxygenation and lung mechanics.
The aim of this study was to describe the impact of two different ventilatory strategies (inverse ratio ventilation vs. conventional ratio ventilation) during one lung ventilation in neonatal open repair of esophageal atresia/tracheoesophageal fistula on the incidence of oxygen desaturation episodes.
We enrolled 40 term neonates undergoing open right thoracotomy for esophageal atresia/tracheoesophageal fistula repair and randomly assigned into two groups based on inspiratory to expiratory ratio of mechanical ventilation parameters (2:1 in inverse ratio ventilation "IRV" and 1:2 in conventional ratio ventilation "CRV"). The incidence of desaturation episodes that required stopping the procedure and reinflation of the lung were recorded as the primary outcome while hemodynamic parameters, incidence of complications, and length of surgical procedure were recorded as the secondary outcomes.
There was a trend toward a reduction in the incidence of severe desaturations (requiring stopping of surgery) with the use of inverse ratio ventilation (15% in IRV vs. 35% in CRV, RR [95% CI] 0.429 [0.129-1.426]). Incidence of all desaturations (including those requiring only an increase in ventilatory support or inspired oxygen saturation) was also reduced (40% in IRV vs. 75% in CRV, RR [95% CI] 0.533 [0.295-0.965]). This in turn affected the length of surgical procedure being significantly shorter in inverse ratio ventilation group (mean difference -16.3, 95% CI -31.64 to -0.958). The intraoperative fraction of inspired oxygen required to maintain adequate oxygen saturation was significantly lower in the inverse ratio ventilation group than in the conventional ratio ventilation group (mean difference -0.22, 95% CI -0.33 to -0.098), with no significant difference in hemodynamic stability or complications apart from higher blood loss in inverse ratio group.
There may be a role for inverse ratio ventilation with appropriate positive end-expiratory pressure to reduce the incidence of hypoxemia during open repair of esophageal atresia/tracheoesophageal fistula in neonates, further studies are required to establish the safety and efficacy of this technique.
在新生儿食管闭锁/气管食管瘘的开放性修复过程中，维持氧合是困难的。在单肺通气期间，可以使用反比通气来改善氧合和肺力学。
本研究旨在描述在新生儿开放性食管闭锁/气管食管瘘修复中单肺通气期间两种不同通气策略（反比通气与常规通气）对氧饱和度下降发作发生率的影响。
我们纳入了 40 例接受右开胸手术治疗食管闭锁/气管食管瘘的足月新生儿，并根据机械通气参数的吸气与呼气比（反比通气为 2:1，常规通气为 1:2）将其随机分为两组。记录需要停止手术并重新充气肺部的氧饱和度下降发作的发生率作为主要结局，同时记录血流动力学参数、并发症发生率和手术时间作为次要结局。
使用反比通气时，严重氧饱和度下降（需要停止手术）的发生率呈下降趋势（反比通气组为 15%，常规通气组为 35%，RR [95%CI] 0.429 [0.129-1.426]）。所有氧饱和度下降（包括仅需要增加通气支持或吸入氧饱和度的下降）的发生率也降低（反比通气组为 40%，常规通气组为 75%，RR [95%CI] 0.533 [0.295-0.965]）。这反过来又影响了手术时间，反比通气组的手术时间明显缩短（平均差异-16.3，95%CI-31.64 至-0.958）。反比通气组维持足够氧饱和度所需的吸入氧分数明显低于常规通气组（平均差异-0.22，95%CI-0.33 至-0.098），除了反比通气组的出血量较高外，两组在血流动力学稳定性或并发症方面无显著差异。
在新生儿食管闭锁/气管食管瘘的开放性修复中，使用适当的呼气末正压的反比通气可能有助于降低低氧血症的发生率，但需要进一步研究来确定该技术的安全性和有效性。
