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Hypoxic preconditioning improves intraoperative oxygenation and postoperative recovery in children undergoing
Ting Xiao1, Lei Wang1, Dong Jie Pei1
1Department of Anesthesiology, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan Children's Hospital), Changsha, Hunan, China.
Insights
Hypoxia preconditioning (HPC) improved oxygenation and recovery in children undergoing lung surgery. Remote ischemic preconditioning (RIPC) did not add benefits, suggesting HPC is a promising lung-protective strategy.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Respiratory Physiology
Background:
- Lung-protective strategies like hypoxia preconditioning (HPC) and remote ischemic preconditioning (RIPC) are under investigation for pediatric thoracic surgery.
- The efficacy of HPC and RIPC in children undergoing video-assisted thoracoscopic pulmonary resection remains to be determined.
Purpose of the Study:
- To evaluate the effects of HPC, alone or combined with RIPC, on lung protection in pediatric patients undergoing thoracoscopic lung surgery.
- To assess the impact of these preconditioning methods on intraoperative oxygenation and postoperative recovery.
Main Methods:
- A 2x2 factorial randomized controlled trial involving 160 children (<18 years) allocated to four groups: Control, HPC, RIPC, and combined HPC+RIPC.
- The primary outcome was the PaO2/FiO2 ratio during one-lung ventilation (OLV). Secondary outcomes included duration of mechanical ventilation, hospital stay, and postoperative pulmonary complications (PPCs).
Main Results:
- HPC significantly improved intraoperative oxygenation (PaO2/FiO2 ratio) compared to the control group (p=0.022).
- HPC reduced mechanical ventilation duration (p<0.001) and hospital length of stay (p=0.001).
- HPC decreased the incidence of PPCs (p=0.021), particularly pleural effusion. RIPC alone or combined with HPC showed no significant additional benefits.
Conclusions:
- HPC is associated with improved intraoperative oxygenation and enhanced postoperative recovery in pediatric patients undergoing thoracoscopic pulmonary surgery.
- HPC represents a simple and promising lung-protective strategy in pediatric thoracic anesthesia.
- RIPC did not provide additional benefits when combined with HPC or used alone in this context.
Background:
Hypoxia preconditioning (HPC) and remote ischemic preconditioning (RIPC) are potential lung-protective strategies, but their efficacy in pediatric thoracic surgery remains unclear. This randomized controlled trial aimed to evaluate the effects of HPC, alone or in combination with RIPC, in children undergoing video-assisted thoracoscopic pulmonary resection.
Methods:
In a single-center, 2 × 2 factorial randomized trial, 160 children (<18 years) undergoing thoracoscopic lung surgery were allocated to four groups: Control (no preconditioning), HPC (three cycles of 5-min hypoxia/ventilation in the non-dependent lung), RIPC (three cycles of 5-min limb ischemia/reperfusion), and combined HPC + RIPC. The primary outcome was the PaO2/FiO2 ratio at 30 min of one-lung ventilation (OLV). Secondary outcomes included the duration of postoperative mechanical ventilation, hospital length of stay, and incidence of postoperative pulmonary complications (PPCs).
Results:
A total of 139 patients were included in the final analysis. Compared with the control group, HPC significantly improved oxygenation at 30 min of OLV (PaO2/FiO2: 256.4 ± 60.3 vs. 201.3 ± 65.0 mmHg; p = 0.022), reduced median mechanical ventilation duration (45 vs. 102.5 min; p < 0.001), and shortened hospital length of stay (7 vs. 11 days; p = 0.001). HPC also reduced the incidence of PPCs (53% vs. 81%; p = 0.021), with the largest reduction observed in pleural effusion. The addition of RIPC did not enhance these outcomes, and RIPC alone had no significant effect.
Conclusion:
HPC was associated with improved intraoperative oxygenation and enhanced postoperative recovery in children undergoing thoracoscopic pulmonary surgery. These findings suggest that HPC may represent a simple and promising lung-protective strategy in pediatric thoracic anesthesia.
Clinical Trial Registration:
Identifier ChiCTR2000038658, https://www.chictr.org.cn/showproj.html?proj=61845.
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