Marchesini Vanessa, Corlette Sebastian, Sheppard Suzette, Davidson Andrew, Tingay David
Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, Melbourne, VIC, Australia.
Department of Anaesthesia, Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia.
BJA Open. 2024 Sep 21;12:100344. doi: 10.1016/j.bjao.2024.100344. eCollection 2024 Dec.
Prolonged mechanical ventilation can create heterogeneous ventilation patterns, which increase the risk of lung injury in infants. However, little is understood about the risk of brief exposure to mechanical ventilation during anaesthesia. The aim of this prospective observational study was to describe the regional pattern of lung ventilation during general anaesthesia in healthy neonates and infants, using electrical impedance tomography.
Twenty infants (age 3 days to 12 months), without known lung disease and receiving general anaesthesia with endotracheal intubation for supine positioned surgery, were included in the study. Anaesthesia and ventilation management was at the discretion of the treating clinician. Standardised lung imaging using electrical impedance tomography was made at six time points during anaesthesia from induction to post-extubation. At each time point, the gravity-dependent and right-left lung centre of ventilation was calculated.
Tidal ventilation favoured the dorsal lung regions at induction, with a median (inter-quartile range) centre of ventilation (CoV) of 58.2 (53.9-59.3)%. After intubation, there was a redistribution of ventilation to the ventral lung, with the greatest change occurring early in surgery: CoV of 53.8 (52.3-55.2)%. After extubation, CoV returned to pre-intubation values: 56.5 (54.7-58)%. Across all time points, the pattern of ventilation favoured the right lung.
General anaesthesia creates heterogenous patterns of ventilation similar to those reported during prolonged mechanical ventilation. This potentially poses a risk for lung injury that may not be recognised clinically. These results suggest the need to better understand the impact of general anaesthesia on the developing lung.
Australian New Zealand Clinical Trials Registry (ACTRN 12616000818437, 22 June 2016).
长时间机械通气可导致通气模式不均一，增加婴儿肺损伤风险。然而，对于麻醉期间短时间接受机械通气的风险了解甚少。这项前瞻性观察性研究的目的是使用电阻抗断层扫描技术描述健康新生儿和婴儿在全身麻醉期间肺通气的区域模式。
本研究纳入20例婴儿（年龄3天至12个月），这些婴儿无已知肺部疾病，因仰卧位手术接受气管插管全身麻醉。麻醉和通气管理由主治医生自行决定。在麻醉期间从诱导到拔管后的六个时间点，使用电阻抗断层扫描进行标准化肺部成像。在每个时间点，计算重力依赖区和左右肺通气中心。
诱导时潮气量通气有利于肺背侧区域，通气中心（CoV）的中位数（四分位间距）为58.2%（53.9 - 59.3%）。插管后，通气重新分布至肺腹侧，最大变化发生在手术早期：CoV为53.8%（52.3 - 55.2%）。拔管后，CoV恢复到插管前值：56.5%（54.7 - 58%）。在所有时间点，通气模式均有利于右肺。
全身麻醉产生的通气模式不均一，与长时间机械通气期间报道的情况相似。这可能会带来临床上未被认识到的肺损伤风险。这些结果表明需要更好地了解全身麻醉对发育中肺的影响。
澳大利亚和新西兰临床试验注册中心（ACTRN 12616000818437，2016年6月22日）。
