Ultrasound-guided versus conventional lung recruitment manoeuvres in laparoscopic gynaecological surgery

医学 肺不张 特伦德伦堡位置 气腹 麻醉 随机对照试验 潮气量 外科 腹腔镜手术 腹腔镜检查 呼吸系统 内科学
作者
Sun-Kyung Park,Hyojun Yang,Seokha Yoo,Won Ho Kim,Young‐Jin Lim,Jae-Hyon Bahk,Jin‐Tae Kim
出处
期刊:European Journal of Anaesthesiology [Lippincott Williams & Wilkins]
卷期号:38 (3): 275-284 被引量:21
标识
DOI:10.1097/eja.0000000000001435
摘要

BACKGROUND Pneumoperitoneum and steep Trendelenburg position promote the formation of pulmonary atelectasis during laparoscopic gynaecological surgery. OBJECTIVE To determine whether lung ultrasound-guided alveolar recruitment manoeuvres could reduce peri-operative atelectasis compared with conventional recruitment manoeuvres during laparoscopic gynaecological surgery. DESIGN Randomised controlled trial. SETTING Tertiary hospital, Republic of Korea, from August 2018 to January 2019. PATIENTS Adult patients scheduled for laparoscopic gynaecological surgery under general anaesthesia. INTERVENTION Forty patients were randomised to receive either ultrasound-guided recruitment manoeuvres (manual inflation until no visibly collapsed area was seen with lung ultrasonography; intervention group) or conventional recruitment manoeuvres (single manual inflation with 30 cmH 2 O pressure; control group). Recruitment manoeuvres were performed 5 min after induction and at the end of surgery in both groups. All patients received volume-controlled ventilation with a tidal volume of 8 ml kg −1 and a positive end-expiratory pressure of 5 cmH 2 O. MAIN OUTCOME MEASURES The primary outcome was the lung ultrasound score at the end of surgery; a higher score indicates worse lung aeration. RESULTS Lung ultrasound scores at the end of surgery were significantly lower in the intervention group compared with control group (median [IQR], 7.5 [6.5 to 8.5] versus 9.5 [8.5 to 13.5]; difference, −2 [95% CI, −4.5 to −1]; P = 0.008). The intergroup difference persisted in the postanaesthesia care unit (7 [5 to 8.8] versus 10 [7.3 to 12.8]; difference, −3 [95% CI, −5.5 to −1.5]; P = 0.005). The incidence of atelectasis was lower in the intervention group compared with control group at the end of surgery (35 versus 80%; P = 0.010) but was comparable in the postanaesthesia care unit (40 versus 55%; P = 0.527). CONCLUSIONS The use of ultrasound-guided recruitment manoeuvres improves peri-operative lung aeration; these effects may persist in the postanaesthesia care unit. However, the long-term effects of ultrasound-guided recruitment manoeuvres on clinical outcomes should be the subject of future trials. TRIAL REGISTRATION ClinicalTrials.gov (NCT03607240).
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