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González-Pizarro P, Acosta CM, Alcaraz García-Tejedor G, Tusman G, Ferrando C, Ricci L, Natal ML, Suarez-Sipmann F. Clinical validation of the Air-Test for the non-invasive detection of perioperative atelectasis in children. Minerva Anestesiol 2024; 90:635-643. [PMID: 39021139 DOI: 10.23736/s0375-9393.24.17933-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
BACKGROUND The incidence of anesthesia-induced atelectasis in children is high and closely related to episodes of hypoxemia. The Air-Test is a simple maneuver to detect lung collapse. By a step-reduction in FiO2 to 0.21, a fall in pulse-oximetry hemoglobin saturation <97% unmasks the presence of collapse-related shunt in healthy lungs. The aim of this study was to validate the Air-Test as a diagnostic tool to detect perioperative atelectasis in children using lung ultrasound as a reference. METHODS We first assessed the Air-Test in a retrospective cohort of 88 anesthetized children (Retrospective study) followed by a prospective study performed in 72 children (45 postconceptional weeks to 16 years old) using a similar protocol (Validation study). We analyzed the performance of the Air-Test to detect atelectasis by an operating characteristic curve (ROC) analysis, using lung ultrasound consolidation score as reference. RESULTS Preoperative SpO2 was normal in both studies (retrospective 98.7±0.6%, validation 99.0±0.9%). The Air-Test, with a SpO2 cut point <97%, resulted positive in 67 patients in the retrospective study (SpO2 93.3±2.1%) and in 59 in the validation study (SpO2 94.9±1.8%); both P<0.0001. In the validation study, the Air-Test showed a sensitivity of 0.91 (95% CI 0.85-0.92), specificity of 1.00 (95% CI 0.84-1) and an area under the curve (AUC) of 0.98 (95% CI 0.97-1.00). AUC between both studies was similar (P=0.16). CONCLUSIONS The Air-Test is a noninvasive and accurate method to detect atelectasis in healthy anesthetized children. It can be used as a screening tool to individualize patients that can benefit from lung recruitment maneuvers.
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Affiliation(s)
- Patricio González-Pizarro
- Department of Pediatric Anesthesia and Critical Care, La Paz Children's University Hospital, Madrid, Spain -
- IdiPaz Research Institute, Madrid, Spain -
| | - Cecilia M Acosta
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar de Plata, Argentina
| | | | - Gerardo Tusman
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar de Plata, Argentina
| | - Carlos Ferrando
- Department of Anesthesiology and Critical Care, Hospital Clínic of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Lila Ricci
- Department of Mathematics, Faculty of Exact Sciences, National University of Mar del Plata, Mar del Plata, Argentina
| | - Marcela L Natal
- Department of Mathematics, Faculty of Exact Sciences, National University of Mar del Plata, Mar del Plata, Argentina
| | - Fernando Suarez-Sipmann
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Department of Intensive Care Medicine, La Princesa University Hospital, Madrid, Spain
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Zannin E, Nguyen J, Vigevani S, Hauser N, Sommerfield D, Dellacà R, Khan RN, Sommerfield A, von Ungern-Sternberg BS. Effect of different lung recruitment strategies and airway device on oscillatory mechanics in children under general anaesthesia. Eur J Anaesthesiol 2024; 41:513-521. [PMID: 38769936 DOI: 10.1097/eja.0000000000001999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Atelectasis has been reported in 68 to 100% of children undergoing general anaesthesia, a phenomenon that persists into the recovery period. Children receiving recruitment manoeuvres have less atelectasis and fewer episodes of oxygen desaturation during emergence. The optimal type of recruitment manoeuvre is unclear and may be influenced by the airway device chosen. OBJECTIVE We aimed to investigate the different effects on lung mechanics as assessed by the forced oscillation technique (FOT) utilising different recruitment strategies: repeated inflations vs. one sustained inflation and different airway devices, a supraglottic airway device vs. a cuffed tracheal tube. DESIGN Pragmatic enrolment with randomisation to the recruitment strategy. SETTING We conducted this single-centre trial between February 2020 and March 2022. PARTICIPANTS Seventy healthy patients (53 boys) aged between 2 and 16 years undergoing general anaesthesia were included. INTERVENTIONS Forced oscillations (5 Hz) were superimposed on the ventilator waveform using a customised system connected to the anaesthesia machine. Pressure and flow were measured at the inlet of the airway device and used to compute respiratory system resistance and reactance. Measurements were taken before and after recruitment, and again at the end of surgery. MAIN OUTCOME MEASURES The primary endpoint measured is the change in respiratory reactance. RESULTS Statistical analysis (linear model with recruitment strategy and airway device as factors) did not show any significant difference in resistance and reactance between before and after recruitment. Baseline reactance was the strongest predictor for a change in reactance after recruitment: prerecruitment Xrs decreased by mean (standard error) of 0.25 (0.068) cmH 2 O s l -1 per 1 cmH 2 O -1 s l -1 increase in baseline Xrs ( P < 0.001). After correcting for baseline reactance, the change in reactance after recruitment was significantly lower for sustained inflation compared with repeated inflation by mean (standard error) 0.25 (0.101) cmH 2 O ( P = 0.0166). CONCLUSION Although there was no significant difference between airway devices, this study demonstrated more effective recruitment via repeated inflations than sustained inflation in anaesthetised children. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12619001434189.
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Affiliation(s)
- Emanuela Zannin
- From the Technologies for Respiration Laboratory, Electronics, Information and Bioengineering Department (DEIB), Politecnico di Milano, Milan (EZ, SV, RD), Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy (EZ), Department of Anaesthesia and Pain Medicine, Perth Children's Hospital (JN, NH, DS, AS, BSvU-S), Perioperative Team, Perioperative Care Program, Telethon Kids Institute (JN, NH, DS, RNK, AS, BSvU-S), Institute for Paediatric Perioperative Excellence (NH, DS, RNK, AS, BSvU-S), Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School (NH, DS, AS, BSvU-S) and Department of Mathematics and Statistics, The University of Western Australia, Perth, Western Australia, Australia (RNK)
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Wu L, Yang L, Yang Y, Wu X, Zhang J. Ultrasound-guided versus conventional lung recruitment manoeuvres in thoracic surgery: a randomised controlled study. J Clin Monit Comput 2024; 38:731-739. [PMID: 38368302 DOI: 10.1007/s10877-024-01134-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/02/2024] [Indexed: 02/19/2024]
Abstract
Lung recruitment manoeuvres (RMs) during mechanical ventilation may reduce atelectasis, however, the optimal recruitment strategy for patients undergoing thoracic surgery remains unknown. Our study was designed to investigate whether ultrasound-guided lung RMs is superior to conventional RMs in reducing perioperative atelectasis during thoracic surgery with one-lung ventilation. We conducted a randomised controlled clinical trial from August 2022 to September 2022. Sixty patients scheduled for video-assisted thoracoscopic surgery (VATS) under general anaesthesia were enrolled. Subjects were randomly divided into the ultrasound-guided RMs group (manual inflation guided by lung ultrasound) or conventional RMs group (manual inflation with 30 cmH2O pressure). Lung ultrasound were performed at three predefined time points (1 min after anaesthetic induction; after RMs at the end of surgery; before discharge from postanesthesia care unit [PACU]). The primary outcome was lung ultrasound score before discharge from the PACU after extubation. In the early postoperative period, lung aeration deteriorated in both groups even after lung RMs. However, ultrasound-guided lung RMs had significantly lower lung ultrasound scores when compared with conventional RMs in bilateral lungs (2.0 [0.8-4.0] vs. 8.0 [3.8-10.3], P < 0.01) at the end of surgery, which remained before patients discharged from the PACU. Accordingly, the lower incidence of atelectasis was found in ultrasound-guided RMs group than in conventional RMs group (7% vs. 53%; P < 0.01) at the end of surgery. Ultrasound-guided RMs is superior to conventional RMs in improving lung aeration and reducing the incidence of lung atelectasis at early postoperative period in patients undergoing VATS. The study protocol was approved by the Institutional Review Board of the Fudan University Shanghai Cancer Center (No. 220,825,810; date of approval: August 5, 2022) and registered on Chinese Clinical Trial Registry (registration number: ChiCTR2200062761).
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Affiliation(s)
- Lei Wu
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, No. 270, Dong'An Road, Xuhui District, Shanghai, 200032, China
| | - Li Yang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, No. 270, Dong'An Road, Xuhui District, Shanghai, 200032, China
| | - Yanyan Yang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, No. 270, Dong'An Road, Xuhui District, Shanghai, 200032, China
| | - Xin Wu
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, No. 270, Dong'An Road, Xuhui District, Shanghai, 200032, China.
| | - Jun Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, No. 270, Dong'An Road, Xuhui District, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dong'An Road, Xuhui District, Shanghai, 200032, China.
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Yang D, Zheng X. Enhanced recovery after surgery program focusing on chest tube management improves surgical recovery after video-assisted thoracoscopic surgery. J Cardiothorac Surg 2024; 19:253. [PMID: 38643197 PMCID: PMC11031910 DOI: 10.1186/s13019-024-02762-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/01/2024] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVE Chest drainage is a standard procedure in thoracoscopic surgery for lung cancer. However, chest tube placement may deteriorate the ventilation capacity and increase difficulty of postoperative management of patients. The study investigated on the effects of enhanced recovery after surgery (ERAS) program focusing on chest tube management on surgical recovery of lung cancer patients. METHODS The study population consisted of 60 patients undergoing video-assisted thoracoscopic surgery (VATS) after implementation of ERAS program and another group of 60 patients undergoing VATS before implementation of ERAS program. RESULTS The mean time of first food intake was 12.9 h required for the ERAS group, which was significantly shorter than 18.4 h required for the control group (p < 0.0001). The mean time of out-of-bed activity was 14.2 h taken for the ERAS group, which was notably shorter than 22.8 h taken for the control group (p < 0.0001). The duration of chest tube placement was 68.6 h in the ERAS group, which was remarkably shorter than 92.8 h in the control group (p < 0.0001). The rate overall postoperative complications were notably lower in the ERAS group than in the control group (p = 0.018). The visual analogue score (VAS) scores on the second postoperative day exhibited significant differences between the ERAS group and the control group (p = 0.017). The patients in the ERAS group had a shorter hospitalization stay than those in the control group (p < 0.0001). CONCLUSION The study suggests the ERAS program focusing on chest tube management could improve surgical recovery, remove patient chest tube earlier, and relieve patient pain after VATS.
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Affiliation(s)
- Dan Yang
- Lung Cancer Center, West China Hospital, Sichuan University/West China School of Nursing, Chengdu, 610000, Sichuan, China
| | - Xi Zheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610000, Sichuan, China.
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Yu LS, Zhou SJ, Chen XH, Wang J, Wang ZC. Single-Lung Ventilation in Infants for Surgical Repair of Coarctation of The Aorta Without Cardiopulmonary Bypass. Braz J Cardiovasc Surg 2024; 39:e20220424. [PMID: 38629954 PMCID: PMC11020275 DOI: 10.21470/1678-9741-2022-0424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 09/08/2023] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To investigate the effect of improving the operative field and postoperative atelectasis of single-lung ventilation (SLV) in the surgical repair of coarctation of the aorta (CoA) in infants without the use of cardiopulmonary bypass (CPB). METHODS This was a retrospective cohort study. The clinical data of 28 infants (aged 1 to 4 months, weighing between 4.2 and 6 kg) who underwent surgical repair of CoA without CPB from January 2019 to May 2022 were analyzed. Fourteen infants received SLV with a bronchial blocker (Group S), and the other 14 infants received routine endotracheal intubation and bilateral lung ventilation (Group R). RESULTS In comparison to Group R, Group S exhibited improved exposure of the operative field, a lower postoperative atelectasis score (P<0.001), reduced prevalence of hypoxemia (P=0.01), and shorter durations of operation, mechanical ventilation, and ICU stay (P=0.01, P<0.001, P=0.03). There was no difference in preoperative information or perioperative respiratory and circulatory indicators before SLV, 10 minutes after SLV, and 10 minutes after the end of SLV between the two groups (P>0.05). Intraoperative bleeding, intraoperative positive end-expiratory pressure (PEEP), and systolic pressure gradient across the coarctation after operation were also not different between the two groups (P>0.05). CONCLUSION This study demonstrates that employing SLV with a bronchial blocker is consistent with enhanced operative field, reduced operation duration, lower prevalence of intraoperative hypoxemia, and fewer postoperative complications during the surgical repair of CoA in infants without the use of CPB.
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Affiliation(s)
- Ling-Shan Yu
- Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian
Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for
Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Si-Jia Zhou
- Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian
Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for
Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiu-Hua Chen
- Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian
Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for
Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Jing Wang
- Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian
Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for
Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zeng-Chun Wang
- Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian
Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for
Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Park JB, Sohn JY, Kang P, Ji SH, Kim EH, Lee JH, Kim JT, Kim HS, Jang YE. Perioperative Respiratory-Adverse Events Following General Anesthesia Among Pediatric Patients After COVID-19. J Korean Med Sci 2023; 38:e349. [PMID: 38050910 PMCID: PMC10695756 DOI: 10.3346/jkms.2023.38.e349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/05/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The perianesthetic morbidity, mortality risk and anesthesia-associated risk after preoperative coronavirus disease 2019 (COVID-19) omicron variant in pediatric patients have not been fully demonstrated. We examined the association between preoperative COVID-19 omicron diagnosis and the incidence of overall perioperative adverse events in pediatric patients who received general anesthesia. METHODS This retrospective study included patients aged < 18 years who received general anesthesia between February 1 and June 10, 2022, in a single tertiary pediatric hospital. They were divided into two groups; patients in a COVID-19 group were matched to patients in a non-COVID-19 group during the omicron-predominant period in Korea. Data on patient characteristics, anesthesia records, post-anesthesia records, COVID-19-related history, symptoms, and mortality were collected. The primary outcomes were the overall perioperative adverse events, including perioperative respiratory adverse events (PRAEs), escalation of care, and mortality. RESULTS In total, 992 patients were included in the data analysis (n = 496, COVID-19; n = 496, non-COVID-19) after matching. The overall incidence of perioperative adverse events was significantly higher in the COVID-19 group than in the non-COVID-19 group (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.89-1.94). The difference was significant for PRAEs (OR, 2.00; 95% CI, 1.96-2.02) but not in escalation of care or mortality. The most pronounced difference between the two groups was observed in instances of high peak inspiratory pressure ≥ 25 cmH2O during the intraoperative period (OR, 11.0; 95% CI, 10.5-11.4). Compared with the non-COVID-19 group, the risk of overall perioperative adverse events was higher in the COVID-19 group diagnosed 0-2 weeks before anesthesia (OR, 6.5; 95% CI, 2.1-20.4) or symptomatic on the anesthesia day (OR, 6.4; 95% CI, 3.30-12.4). CONCLUSION Pediatric patients with the preoperative COVID-19 omicron variant had increased risk of PRAEs. Patients within 2 weeks after COVID-19 or those with symptoms had a higher risk of PRAEs.
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Affiliation(s)
- Jung-Bin Park
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Young Sohn
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Pyoyoon Kang
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
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Qin YJ, Zhang YQ, Chen Q, Wang Y, Li SY. Effect of high-frequency oscillation on reduction of atelectasis in perioperative patients: a prospective randomized controlled study. Ann Med 2023; 55:2272720. [PMID: 37874665 PMCID: PMC10836273 DOI: 10.1080/07853890.2023.2272720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Atelectasis affects approximately 90% of anaesthetized patients, with laparoscopic surgery and pneumoperitoneum reported to exacerbate this condition. High-frequency oscillation therapy applies continuous positive pressure pulses to oscillate the airway, creating a pressure difference in small airways obstructed by secretions. This process helps reduce peak airway pressure, open small airways, and decrease atelectasis incidence, while also facilitating respiratory tract clearance. This study examines the efficacy of high-frequency oscillation on reduction of atelectasis in laparoscopic cholecystectomy (LC) patients under general anaesthesia, evaluated using lung ultrasound. METHODS Sixty-four patients undergoing laparoscopic cholecystectomy were randomly divided into a control group and a high-frequency oscillation (HFO) group. Both groups underwent total intravenous anaesthesia under invasive arterial monitoring. The HFO group received a 10-minute continuous high-frequency oscillation therapy during surgery, while the control group received no intervention. Lung ultrasound evaluations were performed three times: five minutes post-intubation (T1), at the end of the surgery (T2), and before leaving the Post-Anaesthesia Care Unit (PACU; T3). Blood gas analysis was performed twice: prior to induction with no oxygen supply and before PACU discharge (oxygen supply off). RESULTS The HFO group displayed a significantly lower incidence of atelectasis at T3 (57.5% vs. 90.3%, OR 6.88, 95%CI (1.74 to 27.24)) compared to the control group. Moreover, the HFO group's PaO2 levels remained consistent with baseline levels before PACU discharge, unlike the control group. Although there was no significant difference in LUS scores between the groups at T1 (8.56 ± 0.15 vs. 8.19 ± 0.18, p = 0.1090), the HFO group had considerably lower scores at T2 (13.41 ± 0.17 vs.7.59 ± 0.17, p < 0.01) and T3 (13.72 ± 0.14 vs.7.25 ± 0.21, p < 0.01). CONCLUSION Our study indicates that high-frequency oscillation effectively reduces atelectasis in patients undergoing laparoscopic cholecystectomy. Additionally, it can mitigate the decline in oxygen partial pressure associated with atelectasis.
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Affiliation(s)
- Yuan-jun Qin
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Yun-qian Zhang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Qi Chen
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Yan Wang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Si-yuan Li
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China
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Wu L, Yang Y, Yin Y, Yang L, Sun X, Zhang J. Lung ultrasound for evaluating perioperative atelectasis and aeration in the post-anesthesia care unit. J Clin Monit Comput 2023; 37:1295-1302. [PMID: 36961634 DOI: 10.1007/s10877-023-00994-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/07/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE Lung ultrasound is widely accepted as a reliable, noninvasive tool for evaluating lung status at the bedside. We assessed the impact of perioperative variables on atelectasis and lung aeration using lung ultrasound, and their correlation with postoperative oxygenation in patients undergoing general anesthesia. METHODS This prospective observational study evaluated 93 consecutive patients scheduled to undergo elective non-cardiothoracic surgery under general anesthesia. Lung ultrasound was performed 5 min after admission to the post-anesthesia care unit (PACU). Twelve pulmonary quadrants were selected for each ultrasound examination. The lung ultrasound scores and atelectasis status were calculated. The oxygenation assessment was obtained by arterial blood gas analysis before discharge from the PACU. RESULTS Thirty-two patients (34%) had atelectasis in at least one of the 12 evaluated segments, whereas 12 patients (13%) had atelectasis in at least three segments. The proportion of B-lines (≥ 3) and atelectasis in the inferolateral and posterior regions was significantly higher than in other regions. Patients with lung ultrasound scores ≥ 5 had a higher body mass index and lower PaO2 before discharge from the PACU than those with scores < 5. Patients with atelectasis had higher body mass indices and lung ultrasound scores. The presence of ≥ 2 regions of atelectasis was associated with lower PaO2. Using multivariate analysis, body mass index, intraoperative body position, and sex independently correlated with lung ultrasound scores. Age and lung ultrasound scores independently correlated with hypoxemia. CONCLUSION Lung ultrasound enables early postoperative evaluation of atelectasis and lung aeration, which are closely associated with postoperative oxygenation.
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Affiliation(s)
- Lei Wu
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yanyan Yang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yuehao Yin
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Li Yang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xia Sun
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China.
| | - Jun Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dong'an Road, 200032, Xuhui, Shanghai, China.
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Gao Q, Ji H, Wu Z, Zhao P. Effect of ultrasound-guided lung recruitment manoeuvre on perioperative atelectasis during laparoscopy in young infants: A randomised controlled trial. J Clin Anesth 2023; 86:111075. [PMID: 36796214 DOI: 10.1016/j.jclinane.2023.111075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
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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Affiliation(s)
- Qiushi Gao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Haiyin Ji
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ziyi Wu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ping Zhao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.
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Use of Cardio-Pulmonary Ultrasound in the Neonatal Intensive Care Unit. CHILDREN 2023; 10:children10030462. [PMID: 36980020 PMCID: PMC10047372 DOI: 10.3390/children10030462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/11/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023]
Abstract
Cardiopulmonary ultrasound (CPUS), the combination of lung ultrasound (LUS) and targeted neonatal echocardiography (TnECHO)AA, may offer a more appropriate approach to the challenging neonatal cardiovascular and respiratory disorders. This paper reviews the possible use of CPUS in the neonatal intensive care unit (NICU).
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What compromised the effect of reducing atelectasis by lung protective ventilation? Eur J Anaesthesiol 2022; 39:843-845. [PMID: 36101913 DOI: 10.1097/eja.0000000000001733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The effect of ultrasound-guided lung recruitment maneuvers on atelectasis in lung-healthy patients undergoing laparoscopic gynecologic surgery: a randomized controlled trial. BMC Anesthesiol 2022; 22:200. [PMID: 35778701 PMCID: PMC9248140 DOI: 10.1186/s12871-022-01742-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atelectasis is the primary cause of hypoxemia during general anesthesia. This study aimed to evaluate the impact of the combination of recruitment maneuvers (RM) and positive end-expiratory pressure (PEEP) on the incidence of atelectasis in adult women undergoing gynecologic laparoscopic surgery using pulmonary ultrasound. METHODS In this study, 42 patients with healthy lungs undergoing laparoscopic gynecologic surgery were randomly divided into the recruitment maneuver group (RM group; 6 cm H2O PEEP and RM) or the control group (C group; 6 cm H2O PEEP and no RM), 21 patients in each group. Volume-controlled ventilation was used in all selected patients, with a tidal volume of 6-8 mL·kg-1 of ideal body weight. When atelectasis was detected, patients in the RM group received ultrasound-guided RM, while those in the C group received no intervention. The incidence and severity of atelectasis were determined using lung ultrasound scores. RESULTS A total of 41 patients were investigated. The incidence of atelectasis was lower in the RM group (40%) than in the C group (80%) 15 min after arrival in the post-anesthesia care unit (PACU). Meanwhile, lung ultrasound scores (LUSs) were lower in the RM group compared to the C group. In addition, the differences in the LUS between the two groups were mainly due to the differences in lung ultrasound scores in the posterior regions. However, this difference did not persist after 24 h of surgery. CONCLUSIONS In conclusion, the combination of RM and PEEP could reduce the incidence of atelectasis in patients with healthy lungs 15 min after arrival at the PACU; however, it disappeared within 24 h after surgery. TRIAL REGISTRATION (Prospectively registered): ChiCTR2000033529 . Registered on 4/6/2020.
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Bruins S, Sommerfield D, Powers N, von Ungern-Sternberg BS. Atelectasis and lung recruitment in pediatric anesthesia: An educational review. Paediatr Anaesth 2022; 32:321-329. [PMID: 34797011 DOI: 10.1111/pan.14335] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 12/24/2022]
Abstract
General anesthesia is associated with development of pulmonary atelectasis. Children are more vulnerable to the development and adverse effects of atelectasis. We review the physiology and risk factors for the development of atelectasis in pediatric patients under general anesthesia. We discuss the clinical significance of atelectasis, the use and value of recruitment maneuvers, and other techniques available to minimize lung collapse. This review demonstrates the value of a recruitment maneuver, maintaining positive end-expiratory pressure (PEEP) until extubation and lowering FiO2 where possible in the daily practice of the pediatric anesthetist.
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Affiliation(s)
- Suze Bruins
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, WA, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Crawley, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, WA, Australia
| | - Neil Powers
- Department of Medical Imaging, Perth Children's Hospital, Nedlands, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Crawley, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, WA, Australia
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Ruoss JL, Bazacliu C, Cacho N, De Luca D. Lung Ultrasound in the Neonatal Intensive Care Unit: Does It Impact Clinical Care? CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121098. [PMID: 34943297 PMCID: PMC8700415 DOI: 10.3390/children8121098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 02/06/2023]
Abstract
A neonatal point-of-care ultrasound has multiple applications, but its use has been limited in neonatal intensive care units in the Unites States. An increasing body of evidence suggests that lung ultrasound performed by the neonatologist, at the bedside, is reliable and accurate in differentiating neonatal respiratory conditions, predicting morbidity, and guiding invasive interventions. Recent research has shown that a lung ultrasound can assist the clinician in accurately identifying and managing conditions such as respiratory distress syndrome, transient tachypnea of the newborn, and bronchopulmonary dysplasia. In this review, we discuss basic lung ultrasound terminology, evidence for applications of neonatal lung ultrasound, and its use as a diagnostic and predictive tool for common neonatal respiratory pathologies.
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Affiliation(s)
- J. Lauren Ruoss
- Division of Neonatology, University of Florida, Gainesville, FL 32610, USA; (C.B.); (N.C.)
- Correspondence:
| | - Catalina Bazacliu
- Division of Neonatology, University of Florida, Gainesville, FL 32610, USA; (C.B.); (N.C.)
| | - Nicole Cacho
- Division of Neonatology, University of Florida, Gainesville, FL 32610, USA; (C.B.); (N.C.)
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, Paris Saclay University Hospitals, APHP, 94270 Paris, France;
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Kim BR, Lee S, Bae H, Lee M, Bahk JH, Yoon S. Lung ultrasound score to determine the effect of fraction inspired oxygen during alveolar recruitment on absorption atelectasis in laparoscopic surgery: a randomized controlled trial. BMC Anesthesiol 2020; 20:173. [PMID: 32682397 PMCID: PMC7368786 DOI: 10.1186/s12871-020-01090-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/09/2020] [Indexed: 01/28/2023] Open
Abstract
Background Although the intraoperative alveolar recruitment maneuver (RM) efficiently treats atelectasis, the effect of Fio2 on atelectasis during RM is uncertain. We hypothesized that a high Fio2 (1.0) during RM would lead to a higher degree of postoperative atelectasis without benefiting oxygenation when compared to low Fio2 (0.4). Methods In this randomized controlled trial, patients undergoing elective laparoscopic surgery in the Trendelenburg position were allocated to low- (Fio2 0.4, n = 44) and high-Fio2 (Fio2 1.0, n = 46) groups. RM was performed 1-min post tracheal intubation and post changes in supine and Trendelenburg positions during surgery. We set the intraoperative Fio2 at 0.4 for both groups and calculated the modified lung ultrasound score (LUSS) to assess lung aeration after anesthesia induction and at surgery completion. The primary outcome was modified LUSS at the end of the surgery. The secondary outcomes were the intra- and postoperative Pao2 to Fio2 ratio and postoperative pulmonary complications. Results The modified LUSS before capnoperitoneum and RM (P = 0.747) were similar in both groups. However, the postoperative modified LUSS was significantly lower in the low Fio2 group (median difference 5.0, 95% CI 3.0–7.0, P < 0.001). Postoperatively, substantial atelectasis was more common in the high-Fio2 group (relative risk 1.77, 95% CI 1.27–2.47, P < 0.001). Intra- and postoperative Pao2 to Fio2 were similar with no postoperative pulmonary complications. Atelectasis occurred more frequently when RM was performed with high than with low Fio2; oxygenation was not benefitted by a high-Fio2. Conclusions In patients undergoing laparoscopic surgery in the Trendelenburg position, absorption atelectasis occurred more frequently with high rather than low Fio2. No oxygenation benefit was observed in the high-Fio2 group. Trial registration ClinicalTrials.gov, NCT03943433. Registered 7 May 2019,
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Affiliation(s)
- Bo Rim Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seohee Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hansu Bae
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Minkyoo Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jae-Hyon Bahk
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Susie Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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