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Updated: Jun 11, 2025
Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
Risk of pulmonary complications after video-assisted thoracoscopic pulmonary resection in children
Change Zhu1,2, Rufang Zhang3, Saiji Zhang2
1Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Male sex, longer one-lung ventilation, and less surgeon experience increase postoperative pulmonary complication risk in children undergoing lung surgery. Higher PEEP levels may offer protection.
Area of Science:
- Pediatric Thoracic Surgery
- Anesthesiology
- Respiratory Physiology
Background:
- Postoperative pulmonary complications (PPCs) significantly increase mortality and morbidity in pediatric patients.
- Children's unique respiratory physiology (smaller functional residual capacity, greater closing volume) heightens PPC susceptibility.
- Risk factors for PPCs in pediatric lung resection patients require further elucidation.
Purpose of the Study:
- To identify independent risk factors associated with postoperative pulmonary complications in children undergoing video-assisted thoracoscopic surgery (VATS).
- To analyze the impact of intraoperative variables, including ventilation strategies and surgeon experience, on PPC occurrence.
- To provide data for optimizing perioperative management and future research into pediatric ventilation strategies.
Main Methods:
- Retrospective analysis of pediatric patients (<18 years) who underwent VATS between January 2018 and February 2023.
- Primary outcome: incidence of postoperative pulmonary complications.
- Multivariate logistic regression analysis was employed to determine independent risk factors for PPCs.
Main Results:
- A total of 640 children were analyzed, with 18.3% experiencing PPCs.
- Independent risk factors for PPCs included male sex (OR 1.83), longer duration of one-lung ventilation (OLV) (OR 1.01), and less surgeon experience (OR 1.67).
- Positive end-expiratory pressure (PEEP) > 8 mL/kg was identified as a protective factor (OR 0.83), and PPCs correlated with longer hospital stays.
Conclusions:
- Male sex, prolonged OLV duration, limited surgeon experience, and inadequate PEEP levels are significant risk factors for PPCs in pediatric VATS.
- Optimizing PEEP and considering surgeon experience are crucial for mitigating PPCs in this population.
- Findings support the need for prospective studies to investigate targeted ventilation strategies for pediatric thoracic surgery.
Background:
Postoperative pulmonary complications (PPCs) are associated with high mortality and morbidity rates. Children are more susceptible to PPCs owing to smaller functional residual capacity and greater closing volume. Risk factors of PPCs in children undergoing lung resection remain unclear.
Methods:
This retrospective study enrolled children who underwent video-assisted thoracoscopic surgery between January 2018 and February 2023. The primary outcome was PPC occurrence. Multivariate logistic regression was used to analyze risk factors for PPCs.
Results:
Overall, 640 children were analyzed; their median age was 7 (interquartile range: 5-11) months, and the median tidal volume was 7.66 (6.59-8.49) mL/kg. One hundred and seventeen (18.3%) developed PPCs. PPCs were independently associated with male sex (odds ratio [OR], 1.83; 95% confidence interval [CI], 1.17-2.88; P=0.008), longer OLV duration (OR, 1.01; 95% CI, 1.0-1.01; P=0.001), and less surgeon's experience (OR, 1.67; 95% CI, 1.03-2.7; P=0.036). When low-tidal-volume cutoff was defined as <8 mL/kg, PEEP level was a protective factor for PPCs (OR, 0.83; 95% CI, 0.69-1.00; P=0.046). Additionally, PPCs were associated with increased hospital stay (P<0.001).
Conclusions:
Male sex, longer OLV duration, less surgeon's experience, and lower PEEP were risk factors of PPCs in children undergoing video-assisted thoracoscopic surgery. Our findings may serve as targets for prospective studies investigating specific ventilation strategies for children.
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