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Randomized Controlled Trial
. 2024 Jun 22;24(1):211.
doi: 10.1186/s12871-024-02596-5.

Comparison of the effect of two recruitment manoeuvres to conventional ventilation on lung atelectasis in paediatric laparoscopic surgery- a prospective randomised controlled trial

Aditi Jain  1 , Neerja Bhardwaj  2 , Sandhya Yaddanapudi  2 , Indu Mohini Sen  2 , Preethy Mathew  2
Affiliations
Randomized Controlled Trial

Comparison of the effect of two recruitment manoeuvres to conventional ventilation on lung atelectasis in paediatric laparoscopic surgery- a prospective randomised controlled trial

Aditi Jain et al. BMC Anesthesiol. .

Abstract

Background: There is a high incidence of pulmonary atelectasis during paediatric laparoscopic surgeries. The authors hypothesised that utilising a recruitment manoeuvre or using continuous positive airway pressure may prevent atelectasis compared to conventional ventilation.

Objective: The primary objective was to compare the degree of lung atelectasis diagnosed by lung ultrasound (LUS) using three different ventilation techniques in children undergoing laparoscopic surgeries.

Design: Randomised, prospective three-arm trial.

Setting: Single institute, tertiary care, teaching hospital.

Patients: Children of ASA PS 1 and 2 up to the age of 10 years undergoing laparoscopic surgery with pneumoperitoneum lasting for more than 30 min.

Intervention: Random allocation to one of the three study groups: CG group: Inspiratory pressure adjusted to achieve a TV of 5-8 ml/kg, PEEP of 5 cm H2O, respiratory rate adjusted to maintain end-tidal carbon dioxide (ETCO2) between 30-40 mm Hg with manual ventilation and no PEEP at induction. RM group: A recruitment manoeuvre of providing a constant pressure of 30 cm H2O for ten seconds following intubation was applied. A PEEP of 10 cm H2O was maintained intraoperatively. CPAP group: Intraoperative maintenance with PEEP 10 cm H2O with CPAP of 10 cm H2O at induction using mechanical ventilation was done.

Outcome measures: Lung atelectasis score at closure assessed by LUS.

Results: Post induction, LUS was comparable in all three groups. At the time of closure, the LUS for the RM group (8.6 ± 4.9) and the CPAP group (8.8 ± 6.8) were significantly lower (p < 0.05) than the CG group (13.3 ± 3.8). In CG and CPAP groups, the score at closure was significantly higher than post-induction. The PaO2/FiO2 ratio was significantly higher (p < 0.05) for the RM group (437.1 ± 44.9) and CPAP group (421.6 ± 57.5) than the CG group (361.3 ± 59.4) at the time of pneumoperitoneum.

Conclusion: Application of a recruitment manoeuvre post-intubation or CPAP during induction and maintenance with a high PEEP leads to less atelectasis than conventional ventilation during laparoscopic surgery in paediatric patients.

Trial registry: CTRI/2019/08/02058.

Keywords: Paediatric minimally invasive; Recruitment; Ventilation strategy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
a Lung ultrasound with score 0 1b) Position for probe for lung ultrasound in each hemithorax
Fig. 2
Fig. 2
CONSORT diagram
Fig. 3
Fig. 3
a Integroup comparison of lung ultrasound scores b) Trend of lung ultrasound score in each group
See this image and copyright information in PMC

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