AI Article Synopsis
- Pneumoperitoneum and steep Trendelenburg position during laparoscopic gynecological surgery can lead to pulmonary atelectasis, prompting a study to see if ultrasound-guided recruitment maneuvers are more effective than conventional techniques in reducing this issue.
- The study was a randomized controlled trial involving 40 adult patients, with one group receiving ultrasound-guided recruitment and the other conventional recruitment maneuvers during surgery.
- Results showed that patients in the ultrasound-guided group had significantly better lung ultrasound scores (indicating better lung aeration) both at the end of surgery and in the post-anesthesia care unit, and a lower incidence of atelectasis compared to the control group.
Article Abstract
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 cmH2O 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 cmH2O.
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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| http://dx.doi.org/10.1097/EJA.0000000000001435 | DOI Listing |
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