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Published on: April 19, 2024
Effect of regular alveolar recruitment on intraoperative atelectasis in paediatric patients ventilated in the prone
Young-Eun Jang1, Sang-Hwan Ji1, Eun-Hee Kim1
1Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Insights
Regular alveolar recruitment significantly reduced atelectasis in infants and children under three years old after general anesthesia in the prone position, improving patient outcomes.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Physiology
- Critical Care Medicine
Background:
- Infants undergoing general anesthesia in the prone position frequently experience desaturation.
- Atelectasis is a common complication following such procedures.
- Alveolar recruitment strategies are explored to mitigate respiratory complications.
Purpose of the Study:
- To evaluate the efficacy of regular alveolar recruitment in preventing atelectasis.
- To assess the impact of this intervention in pediatric patients under general anesthesia in the prone position.
Main Methods:
- A randomized controlled trial involving children under 3 years old undergoing prolonged general anesthesia in the prone position.
- Intervention group received regular ultrasound-guided alveolar recruitment hourly; control group received standardized care.
- Lung ultrasound assessed significant atelectasis (consolidation score ≥2) before extubation.
Main Results:
- Pre-intervention atelectasis was similar in both groups in supine and prone positions.
- The incidence of significant atelectasis before extubation was substantially lower in the regular recruitment group (8.1%) compared to the standardized care group (47.2%).
- A significant absolute risk reduction of 39.1% for atelectasis was observed with regular alveolar recruitment (P<0.001).
Conclusions:
- Regular alveolar recruitment is an effective strategy to reduce the incidence of atelectasis.
- This intervention benefits infants and children under 3 years old after general anesthesia in the prone position.
- The findings support the integration of regular alveolar recruitment into anesthetic protocols for this patient population.
Background:
Desaturation frequently occurs in infants after general anaesthesia in the prone position. We aimed to evaluate the effect of regular alveolar recruitment in preventing atelectasis in infants and children after general anaesthesia in the prone position.
Methods:
Children (<3 yr) undergoing general anaesthesia (>2 h) in the prone position were randomised to either receive regular alveolar recruitment or standardised care without recruitment. Ultrasound-guided alveolar recruitment was performed for both groups, and mechanical ventilation was started with a tidal volume of 6 ml kg-1 and PEEP of 7 cm H2O. During mechanical ventilation, the intervention (regular recruitment) group received alveolar recruitment once per hour. Lung ultrasound was performed after inducing anaesthesia and each position change. The primary outcome was the incidence of significant atelectasis (defined by consolidation score ≥2 in any region) before extubation, as evaluated by lung ultrasound undertaken by an investigator masked to trial allocation.
Results:
Seventy-three children (regular recruitment: 37; standardised care: 36) were included in the analysis. Before the hourly intervention, atelectasis was similar between children randomised to regular alveolar recruitment or standardised care in both supine (83.3%, both groups; P>0.99) and prone positions (88.9% vs 91.9%; P=0.970). The incidence of atelectasis before extubation was lower in children receiving regular alveolar recruitment (8.1%), compared with 47.2% in children randomised to standardised care (absolute risk reduction: 39.1% [95% confidence interval: 20.6-57.6%); P<0.001).
Conclusions:
Regular alveolar recruitment reduced the incidence of atelectasis at the end of surgery in infants and children <3 yr undergoing general anaesthesia in the prone position.
Clinical Trial Registration:
NCT03486847.
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