背景:据报道,68%至100%的儿童接受全身麻醉,这种现象一直持续到恢复期。接受招募操作的儿童在出现期间肺不张和氧饱和度降低。最佳的募集操作类型尚不清楚,可能会受到所选择的气道装置的影响。
目的:我们旨在研究使用不同募集策略的强迫振荡技术(FOT)对肺力学的不同影响:重复充气与一种持续的充气和不同的气道装置,声门上气道装置与带袖口的气管导管.
方法:在招募策略中随机化的务实注册。
方法:我们在2020年2月至2022年3月之间进行了这项单中心试验。
方法:纳入70名年龄在2至16岁之间接受全身麻醉的健康患者(53名男孩)。
方法:使用连接到麻醉机的定制系统将强制振荡(5Hz)叠加在呼吸机波形上。在气道设备的入口处测量压力和流量,并用于计算呼吸系统电阻和电抗。在招募前后进行测量,再次在手术结束时。
方法:测量的主要终点是呼吸电抗的变化。
结果:统计分析(以募集策略和气道装置为因素的线性模型)未显示募集前后的电阻和电抗有任何显着差异。基线电抗是招募后电抗变化的最强预测因子:招募前Xrs平均减少0.25(0.068)cmH2Osl-1/1cmH2Osl-1(P<0.001)。校正基线电抗后,通过均值(标准误差)0.25(0.101)cmH2O(P=0.0166),与重复通货膨胀相比,持续通货膨胀时招募后的电抗变化显著较低.
结论:尽管气道装置之间没有显着差异,这项研究表明,在麻醉儿童中,通过反复膨胀进行招募比持续膨胀更有效.
背景:澳大利亚新西兰临床试验注册:ACTRN12619001434189。
BACKGROUND: Atelectasis has been reported in 68 to 100% of children undergoing general anaesthesia, a phenomenon that persists into the recovery period. Children receiving recruitment manoeuvres have less atelectasis and fewer episodes of oxygen desaturation during emergence. The optimal type of recruitment manoeuvre is unclear and may be influenced by the airway device chosen.
OBJECTIVE: We aimed to investigate the different effects on lung mechanics as assessed by the forced oscillation technique (FOT) utilising different recruitment strategies: repeated inflations vs. one sustained inflation and different airway devices, a supraglottic airway device vs. a cuffed tracheal tube.
METHODS: Pragmatic enrolment with randomisation to the recruitment strategy.
METHODS: We conducted this single-centre trial between February 2020 and March 2022.
METHODS: Seventy healthy patients (53 boys) aged between 2 and 16 years undergoing general anaesthesia were included.
METHODS: Forced oscillations (5 Hz) were superimposed on the ventilator waveform using a customised system connected to the anaesthesia machine. Pressure and flow were measured at the inlet of the airway device and used to compute respiratory system resistance and reactance. Measurements were taken before and after recruitment, and again at the end of surgery.
METHODS: The primary endpoint measured is the change in respiratory reactance.
RESULTS: Statistical analysis (linear model with recruitment strategy and airway device as factors) did not show any significant difference in resistance and reactance between before and after recruitment. Baseline reactance was the strongest predictor for a change in reactance after recruitment: prerecruitment Xrs decreased by mean (standard error) of 0.25 (0.068) cmH 2 O s l -1 per 1 cmH 2 O -1 s l -1 increase in baseline Xrs ( P < 0.001). After correcting for baseline reactance, the change in reactance after recruitment was significantly lower for sustained inflation compared with repeated inflation by mean (standard error) 0.25 (0.101) cmH 2 O ( P = 0.0166).
CONCLUSIONS: Although there was no significant difference between airway devices, this study demonstrated more effective recruitment via repeated inflations than sustained inflation in anaesthetised children.
BACKGROUND: Australian New Zealand Clinical Trials Registry: ACTRN12619001434189.