Effect of ultrasound-guided lung recruitment manoeuvre on perioperative atelectasis during laparoscopy in young
Qiushi Gao1, Haiyin Ji1, Ziyi Wu1
1Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.
Insights
Ultrasound-guided lung recruitment significantly reduced atelectasis in infants under 3 months undergoing laparoscopic surgery. This method offers a more effective approach to prevent lung complications during general anesthesia.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Pneumoperitoneum during infant laparoscopy increases the risk of perioperative atelectasis.
- Atelectasis is a common lung complication in infants undergoing general anesthesia for surgery.
Purpose of the Study:
- To evaluate the efficacy of ultrasound-guided lung recruitment maneuvers compared to conventional methods.
- To determine if ultrasound guidance improves outcomes for infants under 3 months undergoing laparoscopic surgery.
Main Methods:
- Infants (<3 months) were randomized to conventional or ultrasound-guided lung recruitment during laparoscopic surgery (>2 hours).
- Lung ultrasound (LUS) assessed atelectasis at four time points: pre-intubation, post-pneumoperitoneum, post-surgery, and pre-PACU discharge.
- The primary outcome was significant atelectasis (LUS consolidation score ≥2) at T3 and T4.
Main Results:
- Pre-recruitment atelectasis was similar between groups (T1: 83.3% vs 80.0%; T2: 83.3% vs 76.7%).
- Post-surgery, atelectasis incidence was significantly lower in the ultrasound group (26.7% at T3, 33.3% at T4) compared to the control group (66.7% at T3, 70% at T4).
- P-values for T3 and T4 were <0.01, indicating statistical significance.
Conclusions:
- Ultrasound-guided alveolar recruitment is effective in reducing perioperative atelectasis in young infants.
- This technique offers a promising strategy for managing lung complications in pediatric laparoscopic surgery.
- The study highlights the benefit of real-time ultrasound guidance for lung recruitment in infants.
Background:
Pneumoperitoneum is a risk factor for perioperative atelectasis in infants. This research aimed to investigate whether lung recruitment manoeuvres guided by ultrasound are more effective for young infants (<3 months) during laparoscopy under general anaesthesia.
Methods:
Young infants (<3 months) undergoing general anaesthesia during laparoscopic surgery (>2 h) were randomised to either conventional lung recruitment (control group) or ultrasound-guided lung recruitment (ultrasound group) once per hour. Mechanical ventilation was started with a tidal volume of 8 mL·kg-1, positive end-expiratory pressure of 6 cm H2O and 40% inspired oxygen fraction. Lung ultrasound (LUS) was performed four times (T1 was performed 5 min after intubation and before pneumoperitoneum set, T2 was performed after pneumoperitoneum, T3 was performed 1 min after surgery, and T4 was performed before being discharged from post-anaesthesia care unit [PACU]) in each infant. The primary outcome was the incidence of significant atelectasis at T3 and T4 (defined by LUS consolidation score ≥ 2 in any region).
Results:
62 babies were enrolled in the experiment and 60 infants were included in the analysis. Before the recruitment, atelectasis was similar between infants randomised to the control or ultrasound group at T1 (83.3% vs 80.0%; P = 0.500) and T2 (83,3% vs 76.7%; P = 0.519). The incidence of atelectasis at T3 and T4 were lower in the ultrasound group (26.7% and 33.3%), compared with infants randomised to conventional lung recruitment (66.7% and 70%) (P = 0.002; P = 0.004; respectively).
Conclusions:
Ultrasound-guided alveolar recruitment reduced the perioperative incidence of atelectasis in infants <3 months during laparoscopy under general anaesthesia.
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