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Published on: January 17, 2011
Prevention of atelectasis by continuous positive airway pressure in anaesthetised children: A randomised controlled
Cecilia M Acosta1, María Paz Lopez Vargas, Facundo Oropel
1From the Department of Anaesthesiology Hospital Privado de Comunidad (CMA, FO, GT, LV, MPLV), Department of Mathematics, Facultad de Ciencias Exactas, Universidad Nacional de Mar del Plata, Mar del Plata, Argentina (LR, MN), Hedenstierna Laboratory, Department of surgical Sciences, Uppsala University, Uppsala, Sweden (FSS), CIBERES, Instituto Carlos III (FSS) and Department of Critical Care, Hospital Universitario de La Princesa, Universidad Autonoma de Madrid, Madrid, Spain (FSS).
Insights
Continuous positive airway pressure (CPAP) significantly reduced atelectasis in children undergoing general anesthesia. This intervention proved effective during anesthesia induction and emergence, with benefits persisting postoperatively.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Physiology
- Critical Care Medicine
Background:
- Continuous positive airway pressure (CPAP) is known to prevent peri-operative atelectasis in adults.
- Its efficacy in pediatric patients undergoing general anesthesia has not been well-quantified.
Purpose of the Study:
- To evaluate the effectiveness of CPAP in preventing postinduction and postoperative atelectasis in children.
- To assess the role of CPAP in maintaining lung aeration during general anesthesia.
Main Methods:
- A randomized controlled trial involving 42 children (6 months to 7 years) undergoing general anesthesia.
- Patients were assigned to either a control group or a CPAP group (5 cmH2O) during induction and emergence.
- Lung ultrasound (LUS) imaging was used to assess atelectasis and lung aeration scores before anesthesia, after induction, before extubation, and one hour postoperatively.
Main Results:
- CPAP significantly reduced the incidence of atelectasis after induction (52% vs. 95% in control, P < 0.0001).
- At the end of surgery, atelectasis was observed in 29% of the CPAP group versus 100% of the control group (P < 0.0001).
- Benefits of CPAP, including lower atelectasis rates and better aeration scores, were maintained one hour postoperatively.
Conclusions:
- The application of 5 cmH2O CPAP during anesthesia induction and emergence effectively prevents atelectasis in healthy children.
- The protective effects of CPAP on lung aeration are sustained into the early postoperative period.
Background:
Continuous positive airway pressure (CPAP) prevents peri-operative atelectasis in adults, but its effect in children has not been quantified.
Objective:
The aim of this study was to evaluate the role of CPAP in preventing postinduction and postoperative atelectasis in children under general anaesthesia.
Design:
A randomised controlled study.
Setting:
Single-institution study, community hospital, Mar del Plata. Argentina.
Patients:
We studied 42 children, aged 6 months to 7 years, American Society of Anesthesiologists physical status class I, under standardised general anaesthesia.
Interventions:
Patients were randomised into two groups: Control group (n = 21): induction and emergence of anaesthesia without CPAP; and CPAP group (n = 21): 5 cmH2O of CPAP during induction and emergence of anaesthesia. Lung ultrasound (LUS) imaging was performed before and 5 min after anaesthesia induction. Children without atelectasis were ventilated in the same manner as the Control group with standard ventilatory settings including 5 cmH2O of PEEP. Children with atelectasis received a recruitment manoeuvre followed by standard ventilation with 8 cmH2O of PEEP. Then, at the end of surgery, LUS images were repeated before tracheal extubation and 60 min after awakening.
Main Outcome Measures:
Lung aeration score and atelectasis assessed by LUS.
Results:
Before anaesthesia, all children were free of atelectasis. After induction, 95% in the Control group developed atelectasis compared with 52% of patients in the CPAP group (P < 0.0001). LUS aeration scores were higher (impaired aeration) in the Control group than the CPAP group (8.8 ± 3.8 vs. 3.5 ± 3.3 points; P < 0.0001). At the end of surgery, before tracheal extubation, atelectasis was observed in 100% of children in the Control and 29% of the CPAP group (P < 0.0001) with a corresponding aeration score of 9.6 ± 3.2 and 1.8 ± 2.3, respectively (P < 0.0001). After surgery, 30% of children in the Control group and 10% in the CPAP group presented with residual atelectasis (P < 0.0001) also corresponding to a higher aeration score in the Control group (2.5 ± 3.1) when compared with the CPAP group (0.5 ± 1.5; P < 0.01).
Conclusion:
The use of 5 cmH2O of CPAP in healthy children of the studied age span during induction and emergence of anaesthesia effectively prevents atelectasis, with benefits maintained during the first postoperative hour.
Trial Registry:
Clinicaltrials.gov NCT03461770.
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