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Lung-protective ventilation and postoperative pulmonary complications during pulmonary resection in children: A
Change Zhu1, Mazhong Zhang, Saiji Zhang
1From the Department of Anesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (CZ, SZ, RW), Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China (CZ, MZ), Cardiothoracic Surgery Department, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (RZ).
Insights
Lung-protective ventilation (LPV) did not reduce postoperative pulmonary complications (PPCs) in children undergoing one-lung ventilation (OLV). Driving pressure-guided ventilation showed improved lung mechanics but no significant difference in PPCs.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Physiology
- Critical Care Medicine
Background:
- Children have increased susceptibility to postoperative pulmonary complications (PPCs) due to unique respiratory physiology.
- Lung-protective ventilation (LPV) strategies for pediatric patients requiring one-lung ventilation (OLV) remain underexplored.
- This study investigates LPV and driving pressure-guided ventilation in pediatric OLV.
Purpose of the Study:
- To evaluate the efficacy of lung-protective ventilation (LPV) in reducing postoperative pulmonary complications (PPCs) in children.
- To assess the impact of driving pressure-guided ventilation compared to conventional methods in pediatric OLV.
- To analyze the effects on pulmonary mechanics and oxygenation.
Main Methods:
- A randomized, controlled, double-blind study was conducted with 213 children under 6 years old undergoing lung resection.
- Participants were assigned to either lung-protective ventilation (LPV) or a control group.
- The LPV group was further divided into driving pressure-guided or conventional protective ventilation with fixed PEEP.
Main Results:
- No significant difference in PPC incidence was observed between the LPV and control groups (16.9% vs. 21.1%).
- The driving pressure group exhibited lower driving pressure, improved lung compliance, and better oxygenation compared to the fixed PEEP group.
- Despite improved mechanics, PPC rates did not differ significantly between the driving pressure and fixed PEEP subgroups.
Conclusions:
- Lung-protective ventilation (LPV) did not decrease the occurrence of PPCs compared to non-protective ventilation in this pediatric cohort.
- While driving pressure-guided ventilation improved lung mechanics and oxygenation, these benefits did not translate to a reduction in PPCs.
- The study's small sample size limits definitive conclusions, necessitating larger trials to confirm findings.
Background:
Children are more susceptible to postoperative pulmonary complications (PPCs) due to their smaller functional residual capacity and higher closing volume; however, lung-protective ventilation (LPV) in children requiring one-lung ventilation (OLV) has been relatively underexplored.
Objectives:
To evaluate the effects of LPV and driving pressure-guided ventilation on PPCs in children with OLV.
Design:
Randomised, controlled, double-blind study.
Setting:
Single-site tertiary hospital, 6 May 2022 to 31 August 2023.
Patients:
213 children aged < 6 years, planned for lung resection secondary to congenital cystic adenomatoid malformation.
Interventions:
Children were randomly assigned to LPV ( n = 142) or control ( n = 71) groups. Children in LPV group were randomly assigned to either driving pressure group ( n = 70) receiving individualised positive end-expiratory pressure (PEEP) to deliver the lowest driving pressure or to conventional protective ventilation group ( n = 72) with fixed PEEP of 5 cmH 2 O.
Main Outcome Measures:
The primary outcome was the incidence of PPCs within 7 days after surgery. Secondary outcomes were pulmonary mechanics, oxygenation and mechanical power.
Results:
The incidence of PPCs did not differ between the LPV (24/142, 16.9%) and the control groups (15/71, 21.1%) ( P = 0.45). The driving pressure was lower in the driving pressure group than in the 5 cmH 2 O PEEP group (15 vs. 17 cmH 2 O; P = 0.001). Lung compliance and oxygenation were higher while the dynamic component of mechanical power was lower in the driving pressure group than in the 5 cmH 2 O PEEP group. The incidence of PPCs did not differ between the driving pressure (11/70, 15.7%) and the 5 cmH 2 O PEEP groups (13/72, 18.1%) ( P = 0.71).
Conclusions:
LPV did not decrease the occurrence of PPCs compared to non-protective ventilation. Although lung compliance and oxygenation were higher in the driving pressure group than in the 5 cmH 2 O PEEP group, these benefits did not translate into significant reductions in PPCs. However, the study is limited by a small sample size, which may affect the interpretation of the results. Future research with larger sample sizes is necessary to confirm these findings.
Trial Registration:
ChiCTR2200059270.
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