Effect of an ultrasound-guided lung recruitment manoeuvre on postoperative atelectasis in children

AbstractRespiratory failure may cause hemodynamic instability with strain on the right ventricle. The capnodynamic method continuously calculates cardiac output (CO) based on effective pulmonary blood flow (COEPBF) and could provide CO monitoring complementary to mechanical ventilation during surgery and intensive care. The aim of the current study was to evaluate the ability of a revised capnodynamic method, based on short expiratory holds (COEPBFexp), to estimate CO during acute respiratory failure (LI) with high shunt fractions before and after compliance-based lung recruitment. Ten pigs were submitted to lung lavage and subsequent ventilator-induced lung injury. COEPBFexp, without any shunt correction, was compared to a reference method for CO, an ultrasonic flow probe placed around the pulmonary artery trunk (COTS) at (1) baseline in healthy lungs with PEEP 5 cmH2O (HLP5), (2) LI with PEEP 5 cmH2O (LIP5) and (3) LI after lung recruitment and PEEP adjustment (LIPadj). CO changes were enforced during LIP5 and LIPadj to estimate trending. LI resulted in changes in shunt fraction from 0.1 (0.03) to 0.36 (0.1) and restored to 0.09 (0.04) after recruitment manoeuvre. Bias (levels of agreement) and percentage error between COEPBFexp and COTS changed from 0.5 (− 0.5 to 1.5) L/min and 30% at HLP5 to − 0.6 (− 2.3 to 1.1) L/min and 39% during LIP5 and finally 1.1 (− 0.3 to 2.5) L/min and 38% at LIPadj. Concordance during CO changes improved from 87 to 100% after lung recruitment and PEEP adjustment. COEPBFexp could possibly be used for continuous CO monitoring and trending in hemodynamically unstable patients with increased shunt and after recruitment manoeuvre.

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Ultrasound-Guided Lung Recruitment in a 3-Month-Old Infant With Acute Respiratory Distress Syndrome

Ultrasound Quarterly ◽

10.1097/ruq.0000000000000072 ◽

2014 ◽

Vol 30 (4) ◽

pp. 301-305 ◽

Cited By ~ 9

Author(s):

Yoshino Tamaki Sameshima ◽

João Fernando Lourenço de Almeida ◽

Murilo Marques Almeida Silva ◽

Renata Remondini ◽

Luciana Branco Haddad ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Lung Recruitment ◽

Ultrasound Guided

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Prediction of fluid responsiveness using lung recruitment manoeuvre in paediatric patients receiving lung-protective ventilation

European Journal of Anaesthesiology ◽

10.1097/eja.0000000000001387 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Eun-Hee Kim ◽

Ji-Hyun Lee ◽

Young-Eun Jang ◽

Sang-Hwan Ji ◽

Hee-Soo Kim ◽

...

Keyword(s):

Fluid Responsiveness ◽

Protective Ventilation ◽

Lung Recruitment ◽

Recruitment Manoeuvre ◽

Lung Protective Ventilation ◽

Paediatric Patients

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Correspondence: Ultrasound-guided lung recruitment in a young infant with ARDS

Pediatric Anesthesia ◽

10.1111/j.1460-9592.2010.03379.x ◽

2010 ◽

Vol 20 (9) ◽

pp. 895-896 ◽

Cited By ~ 9

Author(s):

Pierantonio Santuz ◽

Paolo Bonetti ◽

Alessandra Serra ◽

Paolo Biban

Keyword(s):

Young Infant ◽

Lung Recruitment ◽

Ultrasound Guided

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Effects of fluid load on cardiovascular function during stepwise lung recruitment manoeuvre in healthy dogs

The Veterinary Journal ◽

10.1016/j.tvjl.2013.05.013 ◽

2013 ◽

Vol 197 (3) ◽

pp. 800-805 ◽

Cited By ~ 5

Author(s):

S. Canfrán ◽

I.A. Gómez de Segura ◽

R. Cediel ◽

J. García-Fernández

Keyword(s):

Cardiovascular Function ◽

Lung Recruitment ◽

Recruitment Manoeuvre ◽

Fluid Load ◽

Healthy Dogs

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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

10.21203/rs.3.rs-1085907/v1 ◽

2021 ◽

Author(s):

Yi Liu ◽

Jingyu Wang ◽

Yong Wan ◽

Yuan Geng ◽

Yiran Zhang ◽

...

Keyword(s):

Mechanical Ventilation ◽

General Anesthesia ◽

Lung Ultrasound ◽

Pulmonary Complications ◽

Lung Recruitment ◽

Gynecologic Surgery ◽

Postoperative Pulmonary Complications ◽

Ultrasound Guided ◽

Recruitment Maneuvers ◽

Laparoscopic Gynecologic Surgery

Abstract BackgroundAtelectasis is a major cause of hypoxemia during general anesthesia and postoperative pulmonary complications (PPCs).Some previous reported that the combined use of lung recruitment procedures (LRMs) and positive end-expiratory pressure (PEEP) in mechanical ventilation mode contributes to the avoidance of PPCs in patients after general anesthesia, while others suggest that the use of LRMs makes patients more susceptible to hemodynamic disturbances and lung injury, and is of limited potential to decrease the incidence of PPCs. From this perspective, controversy exists as to whether LRMs should be routinely applied to surgical patients. More importantly, corresponding clinical studies are also lacking. Therefore, this trial was conducted with the aim of solving the above problem.MethodsIn current clinical trial, patients undergoing laparoscopic gynecologic surgery with healthy lungs were randomized to the recruitment maneuvers group (RM group; 6 cm H2O PEEP and RMs) and the control group (C group; 6 cm H2O PEEP and no RMs). Lung ultrasound was performed on patients at five separate time points. During mechanical ventilation, patients in the RM group received ultrasound-guided pulmonary resuscitation when atelectasis was detected, while the C group did not intervene. Lung ultrasound scores were used to evaluate the incidence and severity of atelectasis.ResultsAfter LRMs, the incidence of atelectasis was significantly lower in the RM group (40%) than in the C group (80%) 15 minutes after arrival in the post-anesthesia care unit (PACU), and this difference did not persist for 24 hours after surgery. Meanwhile, postoperative pulmonary complications showed no difference between the two groups.ConclusionsThe combination of LRMs and PEEP decreased the incidence of atelectasis 15 minutes after admission to the PACU, but did not improve PPCs in adults with healthy lungs. Hence, for lung-healthy patients undergoing gynecological laparoscopic surgery, we do not recommend routine recruitment maneuvers. Trial registration: (prospectively registered): ChiCTR2000033529. Registered on 6/4/2020.

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Effects of a stepwise lung recruitment manoeuvre and positive end-expiratory pressure on lung compliance and arterial blood oxygenation in healthy dogs

The Veterinary Journal ◽

10.1016/j.tvjl.2012.02.021 ◽

2012 ◽

Vol 194 (1) ◽

pp. 89-93 ◽

Cited By ~ 11

Author(s):

S. Canfrán ◽

I.A. Gómez de Segura ◽

R. Cediel ◽

J. García-Fernández

Keyword(s):

Lung Compliance ◽

Blood Oxygenation ◽

Lung Recruitment ◽

Recruitment Manoeuvre ◽

Positive End Expiratory Pressure ◽

Arterial Blood ◽

Healthy Dogs

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Effect of Ultrasound-guided Lung Recruitment Maneuvers on Atelectasis in Lung-healthy Patients Undergoing Laparoscopic Gynecologic Surgery: a Randomized Controlled Trial

10.21203/rs.3.rs-995493/v1 ◽

2021 ◽

Author(s):

Yi Liu ◽

Jingyu Wang ◽

Yong Wan ◽

Yuan Geng ◽

Yiran Zhang ◽

...

Keyword(s):

Mechanical Ventilation ◽

General Anesthesia ◽

Lung Ultrasound ◽

Pulmonary Complications ◽

Lung Recruitment ◽

Gynecologic Surgery ◽

Postoperative Pulmonary Complications ◽

Ultrasound Guided ◽

Recruitment Maneuvers ◽

Laparoscopic Gynecologic Surgery

Abstract BackgroundAtelectasis is a major cause of hypoxemia during general anesthesia and postoperative pulmonary complications (PPCs).Some previous reported that the combined use of lung recruitment procedures (LRMs) and positive end-expiratory pressure (PEEP) in mechanical ventilation mode contributes to the avoidance of PPCs in patients after general anesthesia, while others suggest that the use of LRMs makes patients more susceptible to hemodynamic disturbances and lung injury, and is of limited potential to decrease the incidence of PPCs. From this perspective, controversy exists as to whether LRMs should be routinely applied to surgical patients. More importantly, corresponding clinical studies are also lacking. Therefore, this trial was conducted with the aim of solving the above problem.MethodsIn current clinical trial, patients undergoing laparoscopic gynecologic surgery with healthy lungs were randomized to the recruitment maneuvers group (RM group; 6 cm H2O PEEP and RMs) and the control group (C group; 6 cm H2O PEEP and no RMs). Lung ultrasound was performed on patients at five separate time points. During mechanical ventilation, patients in the RM group received ultrasound-guided pulmonary resuscitation when atelectasis was detected, while the C group did not intervene. Lung ultrasound scores were used to evaluate the incidence and severity of atelectasis.ResultsAfter LRMs, the incidence of atelectasis was significantly lower in the RM group (40%) than in the C group (80%) 15 minutes after arrival in the post-anesthesia care unit (PACU), and this difference did not persist for 24 hours after surgery. Meanwhile, postoperative pulmonary complications showed no difference between the two groups.ConclusionsThe combination of LRMs and PEEP decreased the incidence of atelectasis 15 minutes after admission to the PACU, but did not improve PPCs in adults with healthy lungs. Hence, for lung-healthy patients undergoing gynecological laparoscopic surgery, we do not recommend routine recruitment maneuvers. Trial registration (prospectively registered)ChiCTR2000033529. Registered on June 4, 2020.

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