Lung Ultrasound for the assessment of lung recruitment in pediatric patients during laparoscopy surgery. A randomized, controlled trial

ACOSTA C. M.; TUSMAN G.; SARA T.; RICCI L.; MOLINARI D.

EUROPEAN JOURNAL OF ANAESTHESIOLOGY

LIPPINCOTT WILLIAMS & WILKINS

Lugar: Philadelphia; Año: 2017

0265-0215

Background and Goal of Study: Atelectasis is a negative side effect of general anesthesia (GA) in pediatric patients. Such atelectasis not only reduceslung compliance but also impairs arterial oxygenation and predisposes to aventilator-induced lung injury. Lung ultrasound (LUS) is a non-invasive reliabletool to detect anesthesia-induced atelectasis in pediatric patients. The aim ofthis study was to compare lung aeration between two different mechanicalventilation strategies (protective mechanical ventilation vs recruitment maneuvers) in pediatric patients scheduled for abdominal laparoscopic surgery using ultrasound imaging.Materials and Methods: Forty-two patients ASA I-II, aged 6 months-7yr wereincluded, randomized to either a protective mechanical ventilation group (PVg), (TV6ml/kg, respiratory rate according with the age of the patients, FiO2 0.5PEEP 5cmH2O) or recruitment maneuver group (RM-g); RM was done beforecapnoperitoneum followed by the same ventilatory setting than the PV-g butthis time using PEEP8 cmH2O.LUS examinations were performed with a linear 6-12MHz probe at three timepoints: T1:after anesthesia induction and before capnoperitoneum, T2:aftercapnoperitoneum and T3:at the end of surgery. An aeration score with a fourpoint-aeration (0=normal lung, 1=moderate aeration loss, 2=severe aerationloss, 3=complete aeration loss and consolidation) was calculated from LUSimages.Results and Discussion: 42 patients (36 men/6 women) aged 46.2±2months, weighing18.5±6.7kg were study. Lung aeration at T1 was decreasedin both groups: RM-g: 5.95±4.13 vs VP-g:5.19±3.33 (p=0.51). (Figure 1)However, the RM group resulted in a lower aeration score compared withPV-g at both T2 and T3: 2.71±2.47 vs 6.71±3.54 (p