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Optimal positive end-expiratory pressure to prevent anaesthesia-induced atelectasis in infants: A prospective,
Sujung Park1, Jae Hoon Lee, Hyun Joo Kim
1From the Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Insights
Positive end-expiratory pressure (PEEP) effectively reduces anesthesia-induced atelectasis in infants. A PEEP of 6 cmH2O proved more beneficial than 3 cmH2O, with 9 cmH2O showing comparable results to 6 cmH2O.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Pediatric patients exhibit a high incidence of anesthesia-induced atelectasis.
- Positive end-expiratory pressure (PEEP) and alveolar recruitment maneuvers are established in adults but understudied in children.
- Anesthesia-induced lung complications pose significant risks in pediatric populations.
Purpose of the Study:
- To compare the efficacy of three PEEP levels (3, 6, and 9 cmH2O) in mitigating anesthesia-induced atelectasis in infants.
- To evaluate the impact of different PEEP levels on lung ultrasound scores in pediatric patients undergoing general anesthesia.
- To assess the effects of PEEP on respiratory mechanics and hemodynamic parameters in infants.
Main Methods:
- Prospective, randomized, double-blind trial involving infants aged 6-12 months with ASA physical status I or II.
- Application of three PEEP levels (3, 6, 9 cmH2O) during general anesthesia for elective surgery.
- Primary outcome: lung ultrasound score at the end of the procedure; secondary outcomes: dynamic compliance, peak inspiratory pressure, driving pressure, cardiac index, mean arterial pressure, and heart rate.
Main Results:
- Mean lung ultrasound scores were significantly lower with PEEP 6 cmH2O (12.8) and 9 cmH2O (12.1) compared to PEEP 3 cmH2O (18.4).
- No significant difference in lung ultrasound scores was observed between PEEP 6 cmH2O and 9 cmH2O.
- Changes in cardiac index were comparable across all three PEEP groups, indicating similar hemodynamic stability.
Conclusions:
- PEEP at 6 cmH2O is more effective than 3 cmH2O in reducing anesthesia-induced atelectasis in healthy infants undergoing specific surgeries.
- A PEEP level of 9 cmH2O demonstrated comparable efficacy to 6 cmH2O in mitigating lung atelectasis.
- These findings support the use of optimized PEEP levels to improve respiratory outcomes in pediatric anesthesia.
Background:
Paediatric patients have a particularly high incidence of anaesthesia-induced atelectasis. Applying positive end-expiratory pressure (PEEP) with an alveolar recruitment manoeuvre has been substantially studied and adopted in adults; however, few studies have been conducted in children.
Objective:
We compared the effects of three levels of PEEP (3, 6 and 9 cmH2O) on anaesthesia-induced atelectasis measured by ultrasound in infants between 6 and 12 months of age who were undergoing general anaesthesia.
Design:
A prospective, randomised, double-blind trial.
Setting:
Department of Anaesthesia, single centre, South Korea, from May 2019 to March 2020.
Patients:
Children who were 6 to 12 months of age, whose American Society of Anesthesiologists (ASA) physical status was 1 or 2, whose height and weight were within two standard deviations of those of their peers, and who were scheduled for elective urological or general surgery were included in the study.
Main Outcome Measures:
The primary outcome was the lung ultrasound score at the end of the procedure. The secondary outcomes included dynamic compliance, peak inspiratory pressure, driving pressure, cardiac index, mean arterial pressure and heart rate before and after applying PEEP.
Results:
The mean lung ultrasound score at the end of operation was 12.8 at PEEP 6 cmH2O and 12.1 at PEEP 9 cmH2O. Both were significantly lower than 18.4 at PEEP 3 cmH2O (P = 0.0002 and 0.00003, respectively). However, there was no significant difference between the scores of PEEP 6 cmH2O and PEEP 9 cmH2O. The Δ cardiac index (the cardiac index after PEEP - the cardiac index at 3 cmH2O of PEEP) was comparable among the three groups.
Conclusion:
To reduce anaesthesia-induced atelectasis measured by ultrasound in healthy infants undergoing low abdominal, genitourinary or superficial regional operations, 6 cmH2O of PEEP was more effective than 3 cmH2O. PEEP of 9 cmH2O was comparable with 6 cmH2O.
Trial Registration:
ClinicalTrials.gov identifier NCT03969173.
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