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Wu XZ, Xia HM, Zhang P, Li L, Hu QH, Guo SP, Li TY. Effects of ultrasound-guided alveolar recruitment manoeuvres compared with sustained inflation or no recruitment manoeuvres on atelectasis in laparoscopic gynaecological surgery as assessed by ultrasonography: a randomized clinical trial. BMC Anesthesiol 2022; 22:261. [PMID: 35974310 PMCID: PMC9380300 DOI: 10.1186/s12871-022-01798-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/03/2022] [Indexed: 12/16/2022] Open
Abstract
Background The majority of patients may experience atelectasis under general anesthesia, and the Trendelenburg position and pneumoperitoneum can aggravate atelectasis during laparoscopic surgery, which promotes postoperative pulmonary complications. Lung recruitment manoeuvres have been proven to reduce perioperative atelectasis, but it remains controversial which method is optimal. Ultrasonic imaging can be conducive to confirming the effect of lung recruitment manoeuvres. The purpose of our study was to assess the effects of ultrasound-guided alveolar recruitment manoeuvres by ultrasonography on reducing perioperative atelectasis and to check whether the effects of recruitment manoeuvres under ultrasound guidance (visual and semiquantitative) on atelectasis are superior to sustained inflation recruitment manoeuvres (classical and widely used) in laparoscopic gynaecological surgery. Methods In this randomized, controlled, double-blinded study, women undergoing laparoscopic gynecological surgery were enrolled. Patients were randomly assigned to receive either lung ultrasound-guided alveolar recruitment manoeuvres (UD group), sustained inflation alveolar recruitment manoeuvres (SI group), or no RMs (C group) using a computer-generated table of random numbers. Lung ultrasonography was performed at four predefined time points. The primary outcome was the difference in lung ultrasound score (LUS) among groups at the end of surgery. Results Lung ultrasound scores in the UD group were significantly lower than those in both the SI group and the C group immediately after the end of surgery (7.67 ± 1.15 versus 9.70 ± 102, difference, -2.03 [95% confidence interval, -2.77 to -1.29], P < 0.001; 7.67 ± 1.15 versus 11.73 ± 1.96, difference, -4.07 [95% confidence interval, -4.81 to -3.33], P < 0.001;, respectively). The intergroup differences were sustained until 30 min after tracheal extubation (9.33 ± 0.96 versus 11.13 ± 0.97, difference, -1.80 [95% confidence interval, -2.42 to -1.18], P < 0.001; 9.33 ± 0.96 versus 10.77 ± 1.57, difference, -1.43 [95% confidence interval, -2.05 to -0.82], P < 0.001;, respectively). The SI group had a significantly lower LUS than the C group at the end of surgery (9.70 ± 1.02 versus 11.73 ± 1.96, difference, -2.03 [95% confidence interval, -2.77 to -1.29] P < 0.001), but the benefit did not persist 30 min after tracheal extubation. Conclusions During general anesthesia, ultrasound-guided recruitment manoeuvres can reduce perioperative aeration loss and improve oxygenation. Furthermore, these effects of ultrasound-guided recruitment manoeuvres on atelectasis are superior to sustained inflation recruitment manoeuvres. Trial registration Chictr.org.cn, ChiCTR2100042731, Registered 27 January 2021, www.chictr.org.cn.
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Affiliation(s)
- Xiong-Zhi Wu
- Department of Anesthesiology, First Affiliated Hospital of Nanchang University, NO. 17, Yongwaizheng Street, Nanchang, Jiangxi, 330006, China.,Department of Anesthesiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), NO.568, North Zhongxing Road, Shaoxing, Zhejiang, China
| | - Hai-Mei Xia
- Department of Anesthesiology, First Affiliated Hospital of Nanchang University, NO. 17, Yongwaizheng Street, Nanchang, Jiangxi, 330006, China
| | - Ping Zhang
- Department of Anesthesiology, Jiangxi Provincial People's Hospital, NO.152 Aiguo Road, Nanchang, Jiangxi, 330006, China
| | - Lei Li
- Department of Anesthesiology, First Affiliated Hospital of Nanchang University, NO. 17, Yongwaizheng Street, Nanchang, Jiangxi, 330006, China
| | - Qiao-Hao Hu
- Department of Anesthesiology, First Affiliated Hospital of Nanchang University, NO. 17, Yongwaizheng Street, Nanchang, Jiangxi, 330006, China
| | - Su-Ping Guo
- Department of Ultrasound Medicine, First Affiliated Hospital of Nanchang University, NO. 17, Yongwaizheng Street, Nanchang, Jiangxi, 330006, China
| | - Tian-Yuan Li
- Department of Anesthesiology, First Affiliated Hospital of Nanchang University, NO. 17, Yongwaizheng Street, Nanchang, Jiangxi, 330006, China.
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Oxygenation Strategies in Critically Ill Patients With COVID-19. Dimens Crit Care Nurs 2021; 40:75-82. [PMID: 33961375 DOI: 10.1097/dcc.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 is the virus that causes coronavirus disease 2019 (COVID-19). COVID-19 is a disease characterized by a range of clinical syndromes including variable degrees of respiratory symptoms from mild respiratory illness and severe interstitial pneumonia to acute respiratory distress syndrome, septic shock, coagulopathies, and multiorgan dysfunction. This virus carries the potential to manifest in a wide range of pulmonary findings and hypoxemias, from mild respiratory symptoms to more severe syndromes, such as acute respiratory distress syndrome. The rapid accumulation of evidence and persistent gaps in knowledge related to the virus presents a host of challenges for clinicians. This creates a complex environment for clinical decision-making. OBJECTIVE To examine oxygenation strategies in critically ill patients with hypoxia who are hospitalized with COVID-19. DISCUSSION These proposed strategies may help to improve the respiratory status and oxygenation of those affected by COVID-19. However, additional high-quality research is needed to provide further evidence for improved respiratory management strategies. Areas of future research should focus on improving understanding of the inflammatory and clotting processes associated with the virus, particularly in the lungs. High-level evidence and randomized controlled trials should target the most effective strategies for improving oxygenation, time requiring mechanical ventilation, and survival for hospitalized patients with COVID-19 presenting with hypoxemia.
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