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Protective Lung Ventilation in Children at Low Risk: Is it Necessary?
56 Pages Posted: 7 Jul 2020
More...Abstract
Background: Protective ventilation is often used to reduce pulmonary complications and we tested the benefit in paediatrics at low risk during general anaesthesia.
Methods: In this randomised controlled trial, we recruited patients who were planned for nonabdominal surgery. Eligible participants were randomly assigned (1:1:1) to receive non-protective ventilation (control group) or low tidal volume with 5 cmH2O positive end-expiratory pressure (PEEP group) or low tidal volume with 5 cmH2O PEEP and recruitment manoeuvres (recruitment group). Lung ultrasonography was undertaken at eight predefined time points. Primary outcome was the difference in lung ultrasonography score and incidence of atelectasis among groups by 24 hours after extubation; a lower score indicates better lung aeration.
Findings: Between 25 July 2019-10 January 2020, 90 eligible patients were randomly assigned and included in the final analysis. Atelectasis was the most common pulmonary complication. Patients in the PEEP and recruitment manoeuvre groups showed lower LUS score after the surgical procedure (H = 57.8, P=0.0001) and immediately after extubation (time point T3) (H =18.2, P=0.0001) compared with patients in the control group; However, this difference did not persist 15 min after extubation. Recruitment maneuvers can lead to hemodynamic instability.
Interpretation: Aeration loss developed most severe immediately after extubation. Then aeration loss gradually improved and disappeared 3 hours after extubation despite ventilatory strategy. Drawing conclusions regarding the importance of an intraoperative protective ventilation strategy for patients at lower risk of atelectasis is challenging.
Trial Registration: This study is registered with the Chinese Clinical Trial Registry (#ChiCTR1800018912).
Funding Statement: None.
Declaration of Interests: The authors declare no competing interests.
Ethics Approval Statement: The study was approved by the research ethics boards of Shanghai Children's Hospital (protocol number: 2019R044-F01, 24July 2019. Written informed consent was obtained from all participants.
Keywords: Protective lung ventilation; postoperative pulmonary complications; atelectasis; ultrasonography
Suggested Citation: Suggested Citation