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

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.

scholarly journals The Effect of Ultrasound-Guided Lung Recruitment Maneuvers On Atelectasis In Lung-Healthy Patients Undergoing Laparoscopic Gynecologic Surgery: a Randomized Controlled Trial

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.

Utility of Perioperative Lung Ultrasound in Pediatric Cardiac Surgery

2018 ◽  
Vol 128 (4) ◽  
pp. 718-727 ◽  
Author(s):  
In-Kyung Song ◽  
Eun-Hee Kim ◽  
Ji-Hyun Lee ◽  
Pyoyoon Kang ◽  
Hee-Soo Kim ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Lung Ultrasound ◽  
Ultrasound Examination ◽  
Recruitment Maneuver ◽  
Intervention Group ◽  
Pulmonary Complications ◽  
Control Group ◽  
Postoperative Pulmonary Complications ◽  
Ultrasound Guided

Abstract Background Pediatric cardiac patients are at risk for perioperative respiratory insufficiency. The objective of this study was to assess the utility of perioperative lung ultrasound examination in pediatric cardiac surgery. Methods In this randomized, controlled trial, children (5 yr old or younger) undergoing cardiac surgery were allocated into a control (n = 61) or intervention (n = 61) group. The control group received only lung ultrasound examinations at the end of surgery and 6 to 12 h after surgery. The intervention group received lung ultrasound examinations and an ultrasound-guided recruitment maneuver depending on ultrasound findings after inducing anesthesia, at the end of surgery, and 6 to 12 h after surgery. Primary outcomes were incidences of intra- and postoperative desaturation, and postoperative pulmonary complications. Multiple comparisons were corrected (P ≤ 0.017) in the primary outcome analysis. Results Of the 120 children included in the analysis, postoperative desaturation (64% vs. 27%; P < 0.001; odds ratio [OR], 0.210; 95% CI, 0.097 to 0.456) occurred more in the control group. The incidences of intraoperative desaturation (36% vs. 19%; P = 0.033; OR, 0.406; 95% CI, 0.176 to 0.939) and postoperative pulmonary complications (12% vs. 3%; P = 0.093; OR, 0.271; 95% CI, 0.054 to 1.361) were similar between the groups. Lung ultrasound scores were better in the intervention group than in the control group. Duration of mechanical ventilation was longer in the control group than in the intervention group (38 ± 43 vs. 26 ± 25 h; 95% CI of mean difference, 0 to 25; P = 0.048). Conclusions Perioperative lung ultrasound examination followed by ultrasound-guided recruitment maneuver helped decrease postoperative desaturation events and shorten the duration of mechanical ventilation in pediatric cardiac patients.

scholarly journals Lung ultrasound score to determine the effect of fraction inspired oxygen during alveolar recruitment on absorption atelectasis in laparoscopic surgery: A randomized controlled trial

2020 ◽  
Author(s):  
Bo Rim Kim ◽  
Seohee Lee ◽  
Hansu Bae ◽  
Minkyoo Lee ◽  
Jae-Hyon Bahk ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Lung Ultrasound ◽  
Controlled Trial ◽  
Pulmonary Complications ◽  
Alveolar Recruitment ◽  
Postoperative Pulmonary Complications ◽  
Trendelenburg Position ◽  
Alveolar Recruitment Maneuver ◽  
Ultrasound Score ◽  
Inspired Oxygen

Abstract Background The intraoperative alveolar recruitment maneuver (ARM) efficiently treats atelectasis, but the effect of Fio 2 during ARM on atelectasis is uncertain. Here, we investigated this effect. Methods Patients undergoing elective laparoscopic surgery in the Trendelenburg position were randomized to low- (Fio 2 0.4; n=44) and high-Fio 2 (Fio 2 1.0, n=46) groups. ARMs were performed 1-min post tracheal intubation and post changes between supine and Trendelenburg positions during surgery. Intraoperative Fio 2 was set at 0.4 for both groups. Modified lung ultrasound (LUS) scores were calculated to assess lung aeration after inducing anesthesia and at surgery completion. The primary outcome was modified LUS score at the end of the surgery, and secondary outcomes were the intra- and postoperative Pao 2 to Fio 2 ratio and postoperative pulmonary complications. Results Both groups presented similar modified LUS scores before capnoperitoneum and ARM ( P =0.747). However, the postoperative modified LUS score was significantly lower in the low- than in the high-Fio 2 group (7.0±4.1 vs 11.7±4.2, mean difference 4.7, 95% CI 2.96–6.44, P <0.001). Significant atelectasis postoperatively was more common in the high-Fio 2 group (relative risk 1.77, 95% CI 1.27‒2.47, P <0.001). Intra- and postoperative Pao 2 to Fio 2 were similar and no postoperative pulmonary complications occurred. Atelectasis occurred more frequently when ARM was performed with high than with low Fio 2 . High-Fio 2 did not benefit oxygenation. Conclusions In patients undergoing laparoscopic surgery in the Trendelenburg position, absorption atelectasis occurred more frequently when the ARM was performed with high rather than low Fio 2 . No oxygenation benefit was observed in the high-Fio 2 group.

scholarly journals Effects of Female Reproductive Hormone Levels on Inadvertent Intraoperative Hypothermia during Laparoscopic Gynecologic Surgery: A Retrospective Study

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1255
Author(s):  
Cheol Lee ◽  
SeongNam Park ◽  
ByoungRyun Kim ◽  
Hyeonbin Yim ◽  
Myeongjong Lee ◽  
...  
Keyword(s):  
Retrospective Study ◽  
General Anesthesia ◽  
Odds Ratio ◽  
Reproductive Hormones ◽  
Gynecologic Surgery ◽  
Reproductive Hormone ◽  
Hormone Levels ◽  
Intraoperative Hypothermia ◽  
Hypothermia Group ◽  
Laparoscopic Gynecologic Surgery

Background and Objectives: Female reproductive hormones may affect core body temperature. This study aimed to investigate the effects of female reproductive hormones on inadvertent intraoperative hypothermia in patients who underwent laparoscopic gynecologic surgery under general anesthesia. Materials and Methods: This retrospective study included 660 menstruating and menopausal female patients aged 19–65 years. The patients were divided into two groups according to the occurrence of inadvertent intraoperative hypothermia: non-hypothermia group (N = 472) and hypothermia group (N = 188). After propensity score matching, 312 patients (N = 156 in each group) were analyzed to investigate the association between intraoperative hypothermia and female reproductive hormones. As potential predictors of inadvertent hypothermia, the levels of female reproductive hormones were analyzed using binary logistic regression. Results: The association of estradiol (r = −0.218, p = 0.000) and progesterone (r = −0.235, p = 0.000) levels with inadvertent intraoperative hypothermia was significant but weakly negative before matching; however, it was significant and moderately negative after matching (r = −0.326, p = 0.000 and r = −0.485, p = 0.000, respectively). In a binary logistic analysis, the odds ratio for estradiol was 0.995 (p = 0.014, 0.993 < 95% confidence interval [CI] < 0.998) before matching and 0.993 (p = 0.000, 0.862 < 95% CI < 0.930) after matching, and that for progesterone was 0.895 (p = 0.000, 0.862 < 95% CI < 0.930) before matching and 0.833 (p = 0.014, 0.990 < 95% CI < 0.996) after matching. Conclusions: Estradiol and progesterone levels were associated with inadvertent intraoperative hypothermia. However, the odds ratio for female reproductive hormone levels was close to 1. Therefore, female reproductive hormones may not be a risk factor for hypothermia during gynecologic surgery under general anesthesia. However, a small sample size in this study limits the generalizability of the results.

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