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Feasibility of postural lung recruitment maneuver in children: a randomized, controlled study
Cecilia M Acosta1, Giovanni Volpicelli2, Nadia Rudzik1
1Department of Anesthesiology, Hospital Privado de Comunidad, Córdoba 4545, 7600, Mar del Plata, Buenos Aires, Argentina.
Insights
A new postural lung recruitment maneuver (P-RM) improved lung aeration and compliance in anesthetized children. This technique opens collapsed lung areas using position changes, unlike traditional methods that may harm hemodynamics.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Physiology
- Critical Care Medicine
Background:
- Pulmonary atelectasis is common in anesthetized children and can be reversed with lung recruitment maneuvers.
- Traditional lung recruitment maneuvers can increase airway pressure, potentially causing hemodynamic instability.
- A novel postural lung recruitment maneuver (P-RM) aims to improve lung aeration using position changes with moderated ventilation pressures.
Purpose of the Study:
- To assess the effect and feasibility of a novel postural lung recruitment maneuver (P-RM) in pediatric patients.
- To compare lung aeration and respiratory compliance between P-RM and a control group receiving standard recruitment.
Main Methods:
- Forty children (6 months to 7 years) undergoing general anesthesia were randomized into two groups: P-RM (n=20) and control (n=20).
- The P-RM group underwent position changes (lateral, supine) during ventilation with increased PEEP (10 cmH2O) and driving pressure (12 cmH2O).
- Lung aeration (ultrasound score) and respiratory compliance were measured before and after the maneuver.
Main Results:
- Both groups had similar baseline aeration scores and respiratory compliance.
- The P-RM group showed a significant decrease in aeration score post-maneuver (p < 0.001), while the control group remained unchanged (p = 0.221).
- Respiratory compliance was significantly higher in the P-RM group (18 mL/cmH2O) compared to the control group (14 mL/cmH2O) (p = 0.001).
Conclusions:
- The postural lung recruitment maneuver (P-RM) strategy led to improved lung aeration and compliance.
- This suggests P-RM is a feasible and potentially beneficial technique for managing atelectasis in pediatric anesthesia.
Background:
Pulmonary atelectasis in anesthetized children is easily reverted by lung recruitment maneuvers. However, the high airways pressure reached during the maneuver could negatively affect hemodynamics. The aim of this study is to assess the effect and feasibility of a postural lung recruitment maneuver (P-RM); i.e., a new maneuver that opens up the atelectatic lung areas based on changing the child's body position under constant ventilation with moderated driving pressure (12 cmH2O) and of positive end-expiratory pressure (PEEP, 10 cmH2O). Forty ASA I-II children, aged 6 months to 7 years, subjected to general anesthesia were studied. Patients were ventilated with volume control mode using standard settings with 5 cmH2O of PEEP. They were randomized into two groups: (1) control group (C group, n = 20)-ventilation was turned to pressure control ventilation using a fixed driving pressure of 12 cmH2O. PEEP was increased from 5 to 10 cmH2O during 3 min maintaining the supine position. (2) P-RM group (n = 20)-patients received the same increase in driving pressure and PEEP, but they were placed, respectively, in the left lateral position, in the right lateral position (90 s each), and back again into the supine position after 3 min. Then, ventilation returned to baseline settings in volume control mode. Lung ultrasound-derived aeration score and respiratory compliance were assessed before (T1) and after (T2) 10 cmH2O of PEEP was applied.
Results:
At baseline ventilation (T1), both groups showed similar aeration score (P-RM group 9.9 ± 1.9 vs C group 10.4 ± 1.9; p = 0.463) and respiratory compliance (P-RM group 15 ± 6 vs C group 14 ± 6 mL/cmH2O; p = 0.517). At T2, the aeration score decreased in the P-RM group (1.5 ± 1.6 vs 9.9 ± 2.1; p < 0.001), but remained without changes in the C group (9.9 ± 2.1; p = 0.221). Compliance was higher in the P-RM group (18 ± 6 mL/cmH2O) when compared with the C group (14 ± 5 mL/cmH2O; p = 0.001).
Conclusion:
Lung aeration and compliance improved only in the group in which a posture change strategy was applied.
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