PDF(Pubmed)
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.
METHODS: Randomised, prospective three-arm trial.
METHODS: Single institute, tertiary care, teaching hospital.
METHODS: 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.
METHODS: 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.
METHODS: 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.
CONCLUSIONS: 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.
BACKGROUND: CTRI/2019/08/02058.
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.
METHODS: Randomised, prospective three-arm trial.
METHODS: Single institute, tertiary care, teaching hospital.
METHODS: 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.
METHODS: 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.
METHODS: 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.
CONCLUSIONS: 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.
BACKGROUND: CTRI/2019/08/02058.
摘要：
背景：小儿腹腔镜手术中肺不张的发生率很高。作者假设，与常规通气相比，使用招募策略或使用持续气道正压可以预防肺不张。
目的：主要目的是比较在接受腹腔镜手术的儿童中使用三种不同的通气技术通过肺部超声（LUS）诊断的肺不张程度。
方法：随机，前瞻性三臂试验。
方法：单一研究所，三级护理，教学医院。
方法：年龄在10岁以下的ASAPS1和2的儿童接受持续30分钟以上的气腹腹腔镜手术。
方法：随机分配到三个研究组之一：CG组：调整吸气压力以达到5-8ml/kg的TV，5cmH2O的PEEP，通过手动通气和诱导时无PEEP，调整呼吸频率以维持潮气末二氧化碳（ETCO2）在30-40mmHg之间。RM组:应用在插管后10秒提供30cmH2O的恒定压力的募集操作。术中维持10cmH2O的PEEP。CPAP组：使用机械通气进行PEEP10cmH2O和CPAP10cmH2O的术中维持。
方法：通过LUS评估闭合时的肺不张评分。
结果：诱导后，LUS在所有三组中具有可比性。在关闭的时候，RM组（8.6±4.9）和CPAP组（8.8±6.8）的LUS显着低于CG组（13.3±3.8）（p<0.05）。在CG和CPAP组中，闭合时的评分显著高于诱导后.气腹时，RM组（437.1±44.9）和CPAP组（421.6±57.5）的PaO2/FiO2比值明显高于CG组（361.3±59.4）（p<0.05）。
结论：在儿科患者腹腔镜手术中，在高PEEP的诱导和维持过程中，插管或CPAP后的募集操作与常规通气相比，导致肺不张减少。
背景：CTRI/2019/08/02058。
目的：主要目的是比较在接受腹腔镜手术的儿童中使用三种不同的通气技术通过肺部超声（LUS）诊断的肺不张程度。
方法：随机，前瞻性三臂试验。
方法：单一研究所，三级护理，教学医院。
方法：年龄在10岁以下的ASAPS1和2的儿童接受持续30分钟以上的气腹腹腔镜手术。
方法：随机分配到三个研究组之一：CG组：调整吸气压力以达到5-8ml/kg的TV，5cmH2O的PEEP，通过手动通气和诱导时无PEEP，调整呼吸频率以维持潮气末二氧化碳（ETCO2）在30-40mmHg之间。RM组:应用在插管后10秒提供30cmH2O的恒定压力的募集操作。术中维持10cmH2O的PEEP。CPAP组：使用机械通气进行PEEP10cmH2O和CPAP10cmH2O的术中维持。
方法：通过LUS评估闭合时的肺不张评分。
结果：诱导后，LUS在所有三组中具有可比性。在关闭的时候，RM组（8.6±4.9）和CPAP组（8.8±6.8）的LUS显着低于CG组（13.3±3.8）（p<0.05）。在CG和CPAP组中，闭合时的评分显著高于诱导后.气腹时，RM组（437.1±44.9）和CPAP组（421.6±57.5）的PaO2/FiO2比值明显高于CG组（361.3±59.4）（p<0.05）。
结论：在儿科患者腹腔镜手术中，在高PEEP的诱导和维持过程中，插管或CPAP后的募集操作与常规通气相比，导致肺不张减少。
背景：CTRI/2019/08/02058。
