Wang Sheng-Hua, Wang Ye, Li Si-Yuan, Jiang Lai, Mao Yan-Fei, Xia Qin, Gan Han
Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China.
Clinical Medical School, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China.
Int J Med Sci. 2025 Jun 12;22(12):3007-3013. doi: 10.7150/ijms.112280. eCollection 2025.
Atelectasis is common during perioperative period in children. Although positive end positive end-expiratory pressure (PEEP) has been identified as a lung protective ventilation strategy to alleviate atelectasis, there's still no consensus on the optimal value of PEEP. We hypothesized that individualized PEEP titrated by electrical impedance tomography (EIT) may reduce the incidence of postoperative atelectasis. A total of 50 children aged between 2 to 7, undergoing laparoscopic hernia repair, were randomly divided into two groups according to the principle of randomization: a control group (PEEP5) and an experimental group (EIT). In the control group, PEEP was set to a fixed value of 5mmHg during pneumoperitoneum mechanical ventilation. The EIT group received an individualized PEEP determined by a decremental PEEP titration using EIT. Ultrasonic assessment and score of atelectasis were carried out post-intubation, post-surgery, and one hour post-extubation. For this study, a total of 12 lung regions were evaluated by Lung ultrasonography, and significant atelectasis was defined by a consolidation score of at least 2 in any region. The primary outcome was the incidence of atelectasis at post-surgery. The incidence of atelectasis after surgery was 92% in the control groups (n=25) and 64% in the EIT groups (n=25), respectively (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.094 to 4.827; P = 0.037). The incidence of atelectasis after 1h post-extubation was 80% in the control groups (n=20) and 48% in the EIT groups (n=12), respectively (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.149 to 2.215; P = 0.038). Both lung consolidations and B-lines score were significantly higher in control group than in the EIT group after surgery (consolidations: 9 vs. 7, P = 0.027; B-lines: 11 vs. 8, P = 0.002) and 1h post-extubation (consolidations: 7 vs. 4, P = 0.018; B-lines: 7 vs. 5, P = 0.037). Lung compliance using optimal PEEP during mechanical ventilation was 20.0±3.3 ml/cm HO. The desaturation (pulse oximeter value is below 95%) after extubation was observed in 7 in the control group and 1 in the EIT group (P = 0.048). Hemodynamics were stable during titration. EIT-directed individualized PEEP titration can reduce the incidence and severity of postoperative atelectasis in children undergoing laparoscopic surgery.
肺不张在儿童围手术期很常见。尽管呼气末正压通气（PEEP）已被确定为一种减轻肺不张的肺保护性通气策略，但关于PEEP的最佳值仍未达成共识。我们假设通过电阻抗断层扫描（EIT）滴定的个体化PEEP可能会降低术后肺不张的发生率。共有50名年龄在2至7岁之间、接受腹腔镜疝修补术的儿童，根据随机化原则随机分为两组：对照组（PEEP5）和实验组（EIT）。在对照组中，气腹机械通气期间PEEP设定为固定值5mmHg。EIT组接受通过使用EIT进行递减PEEP滴定确定的个体化PEEP。在插管后、手术后和拔管后1小时进行肺不张的超声评估和评分。对于本研究，通过肺部超声评估了总共12个肺区域，任何区域的实变评分至少为2定义为显著肺不张。主要结局是术后肺不张的发生率。对照组（n = 25）和EIT组（n = 25）术后肺不张的发生率分别为92%和64%（优势比[OR]，0.72；95%置信区间[CI]，0.094至4.827；P = 0.037）。拔管后1小时，对照组（n = 20）和EIT组（n = 12）肺不张的发生率分别为80%和48%（优势比[OR]，0.59；95%置信区间[CI]，0.149至2.215；P = 0.038）。术后及拔管后1小时，对照组的肺实变和B线评分均显著高于EIT组（实变：9比7，P = 0.027；B线：11比8，P = 0.002）以及（实变：7比4，P = 0.018；B线：7比5，P = 0.037）。机械通气期间使用最佳PEEP时的肺顺应性为20.0±3.3 ml/cm H₂O。对照组有7例出现拔管后去饱和（脉搏血氧饱和度值低于95%），EIT组有1例（P = 0.048）。滴定过程中血流动力学稳定。EIT指导的个体化PEEP滴定可降低接受腹腔镜手术儿童术后肺不张的发生率和严重程度。
