Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Anesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Minerva Anestesiol. 2024 Oct;90(10):882-891. doi: 10.23736/S0375-9393.24.18142-4.
Postoperative pulmonary complications (PPCs) are associated with high mortality and morbidity rates. Children are more susceptible to PPCs owing to smaller functional residual capacity and greater closing volume. Risk factors of PPCs in children undergoing lung resection remain unclear.
This retrospective study enrolled children who underwent video-assisted thoracoscopic surgery between January 2018 and February 2023. The primary outcome was PPC occurrence. Multivariate logistic regression was used to analyze risk factors for PPCs.
Overall, 640 children were analyzed; their median age was 7 (interquartile range: 5-11) months, and the median tidal volume was 7.66 (6.59-8.49) mL/kg. One hundred and seventeen (18.3%) developed PPCs. PPCs were independently associated with male sex (odds ratio [OR], 1.83; 95% confidence interval [CI], 1.17-2.88; P=0.008), longer OLV duration (OR, 1.01; 95% CI, 1.0-1.01; P=0.001), and less surgeon's experience (OR, 1.67; 95% CI, 1.03-2.7; P=0.036). When low-tidal-volume cutoff was defined as <8 mL/kg, PEEP level was a protective factor for PPCs (OR, 0.83; 95% CI, 0.69-1.00; P=0.046). Additionally, PPCs were associated with increased hospital stay (P<0.001).
Male sex, longer OLV duration, less surgeon's experience, and lower PEEP were risk factors of PPCs in children undergoing video-assisted thoracoscopic surgery. Our findings may serve as targets for prospective studies investigating specific ventilation strategies for children.
术后肺部并发症（PPCs）与高死亡率和发病率有关。由于儿童的功能残气量较小，闭合容积较大，因此更容易发生 PPCs。接受肺切除术的儿童 PPCs 的危险因素仍不清楚。
本回顾性研究纳入了 2018 年 1 月至 2023 年 2 月期间接受电视辅助胸腔镜手术的儿童。主要结局为 PPC 发生情况。采用多变量逻辑回归分析 PPCs 的危险因素。
共有 640 名儿童被分析；中位年龄为 7 个月（四分位距：5-11），中位潮气量为 7.66（6.59-8.49）mL/kg。117 名（18.3%）发生 PPCs。PPCs 与男性性别（比值比[OR]，1.83；95%置信区间[CI]，1.17-2.88；P=0.008）、较长的单肺通气（OLV）时间（OR，1.01；95% CI，1.0-1.01；P=0.001）和较少的外科医生经验（OR，1.67；95% CI，1.03-2.7；P=0.036）独立相关。当低潮气量截定点定义为<8 mL/kg 时，PEEP 水平是 PPCs 的保护因素（OR，0.83；95% CI，0.69-1.00；P=0.046）。此外，PPCs 与住院时间延长相关（P<0.001）。
男性、较长的 OLV 时间、较少的外科医生经验和较低的 PEEP 是儿童接受电视辅助胸腔镜手术时 PPCs 的危险因素。我们的发现可能成为针对儿童特定通气策略的前瞻性研究的目标。
