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Liu T, Huang J, Wang X, Tu J, Wang Y, Xie C. Effect of recruitment manoeuvres under lung ultrasound-guidance and positive end-expiratory pressure on postoperative atelectasis and hypoxemia in major open upper abdominal surgery: A randomized controlled trial. Heliyon 2023; 9:e13348. [PMID: 36755592 PMCID: PMC9900369 DOI: 10.1016/j.heliyon.2023.e13348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 01/11/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Background Postoperative pulmonary complications (PPCs) especially atelectasis and hypoxemia are common during abdominal surgery. Studies on the effect of either recruitment manoeuvres (RMs) or positive end-expiratory pressure (PEEP) on PPCs are controversial. The objective of this study is to evaluate the effect of perioperative lung ultrasound (LUS)-guided RMs combined with PEEP on the reduction of postoperative atelectasis and hypoxemia in major open upper abdominal surgery. Methods In this randomized controlled trial, 122 adult patients undergoing major open upper abdominal surgery were allocated into three groups: control (C) group (n = 42); PEEP (P) group (n = 40); RMs combined with PEEP (RP) group (n = 40). All patients were scheduled for general anaesthesia using the lung-protective ventilation (LPV) strategy. The levels of PEEP in the three groups were 0 cmH2O, 5 cmH2O and 5 cmH2O. LUS examination was carried out at 3 predetermined time points in each group: 5 min after intubation (T1), at the end of surgery (T2) and 15 min after extubation (T3). Patients with atelectasis on the sonogram in the RP group received LUS-guided RMs at point T2. LUS scores were used to estimate the severity of aeration loss. The P/F ratio (PaO2/FiO2) at 15min after extubation was used to assess the incidence of postoperative hypoxemia. Primary outcomes were the incidences of postoperative atelectasis and hypoxemia (PaO2/FiO2 < 300 mmHg). The secondary outcome was the distribution of LUS scores in each lung area. Results From July 2021 to December 2021, 122 consecutive patients were enrolled. No typical atelectasis was observed 5 min after intubation. The incidence of atelectasis was 52.4%, 50.0% and 42.5% in the C group, P group and RP group at the end of surgery, respectively. The rate of atelectasis in the C group, P group and RP group (after RMs) was 52.4%, 50.0% and 17.5%, respectively, 15 min after extubation (P < 0.01). The frequency of postoperative hypoxemia was 27.5%, 15.0% and 5.0% in the C group, P group and RP group, respectively (P < 0.017). The increased LUS scores mainly occurred in the superoposterior and inferoposterior quadrants at the end of surgery. Only in the RP group demonstrated a decreased LUS score in the posteriorquadrants after extubation. Conclusions In patients undergoing major open upper abdominal surgery, an intraoperative mechanical ventilation strategy without PEEP or with PEEP alone did not reduce PPCs. However, PEEP of 5 cmH2O combined with LUS-guided RMs proved feasible and beneficial to decrease the occurrence of postoperative atelectasis and hypoxemia in major open upper abdominal surgeries.
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Affiliation(s)
- Tao Liu
- Department of Anesthesiology, The First People's Hospital of Huzhou, The Affiliated Hospital of Huzhou Teachers College, Guangchanghou Road 158th, Huzhou, 313000, PR China
| | - Jiapeng Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY, 40202, USA
| | - Xinqiang Wang
- Department of Anesthesiology, The First People's Hospital of Huzhou, The Affiliated Hospital of Huzhou Teachers College, Guangchanghou Road 158th, Huzhou, 313000, PR China
| | - Jiahui Tu
- Department of Anesthesiology, The First People's Hospital of Huzhou, The Affiliated Hospital of Huzhou Teachers College, Guangchanghou Road 158th, Huzhou, 313000, PR China
| | - Yahong Wang
- Department of Anesthesiology, The First People's Hospital of Huzhou, The Affiliated Hospital of Huzhou Teachers College, Guangchanghou Road 158th, Huzhou, 313000, PR China
| | - Chen Xie
- Department of Anesthesiology, The First People's Hospital of Huzhou, The Affiliated Hospital of Huzhou Teachers College, Guangchanghou Road 158th, Huzhou, 313000, PR China,Corresponding author.
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Peel JK, Funk DJ, Slinger P, Srinathan S, Kidane B. Positive end-expiratory pressure and recruitment maneuvers during one-lung ventilation: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2020; 160:1112-1122.e3. [DOI: 10.1016/j.jtcvs.2020.02.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 02/13/2020] [Accepted: 02/15/2020] [Indexed: 01/09/2023]
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Xie C, Sun K, You Y, Ming Y, Yu X, Yu L, Huang J, Yan M. Feasibility and efficacy of lung ultrasound to investigate pulmonary complications in patients who developed postoperative Hypoxaemia-a prospective study. BMC Anesthesiol 2020; 20:220. [PMID: 32873237 PMCID: PMC7461251 DOI: 10.1186/s12871-020-01123-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/09/2020] [Indexed: 12/18/2022] Open
Abstract
Background Postoperative pulmonary complications (PPCs) and hypoxaemia are associated with morbidity and mortality. We aimed to evaluate the feasibility and efficacy of lung ultrasound (LUS) to diagnose PPCs in patients suffering from hypoxaemia after general anaesthesia and compare the results to those of thoracic computed tomography (CT). Methods Adult patients who received general anaesthesia and suffered from hypoxaemia in the postanaesthesia care unit (PACU) were analysed. Hypoxaemia was defined as an oxygen saturation measured by pulse oximetry (SPO2) less than 92% for more than 30 s under ambient air conditions. LUS was performed by two trained anaesthesiologists once hypoxaemia occurred. After LUS examination, each patient was transported to the radiology department for thoracic CT scan within 1 h before returning to the ward. Results From January 2019 to May 2019, 113 patients (61 men) undergoing abdominal surgery (45 patients, 39.8%), video-assisted thoracic surgery (31 patients, 27.4%), major orthopaedic surgery (17 patients, 15.0%), neurosurgery (10 patients, 8.8%) or other surgery (10 patients, 8.8%) were included. CT diagnosed 327 of 1356 lung zones as atelectasis, while LUS revealed atelectasis in 311 of the CT-confirmed zones. Pneumothorax was detected by CT scan in 75 quadrants, 72 of which were detected by LUS. Pleural effusion was diagnosed in 144 zones on CT scan, and LUS detected 131 of these zones. LUS was reliable in diagnosing atelectasis (sensitivity 98.0%, specificity 96.7% and diagnostic accuracy 97.2%), pneumothorax (sensitivity 90.0%, specificity 98.9% and diagnostic accuracy 96.7%) and pleural effusion (sensitivity 92.9%, specificity 96.0% and diagnostic accuracy 95.1%). Conclusions Lung ultrasound is feasible, efficient and accurate in diagnosing different aetiologies of postoperative hypoxia in healthy-weight patients in the PACU. Trial registration Current Controlled Trials NCT03802175, 2018/12/05, www.ClinicalTrials.gov
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Affiliation(s)
- Chen Xie
- Department of Anesthesiology and Pain Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88th, Hangzhou, 310016, People's Republic of China
| | - Kai Sun
- Department of Anesthesiology and Pain Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88th, Hangzhou, 310016, People's Republic of China
| | - Yueyang You
- Department of Anesthesiology and Pain Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88th, Hangzhou, 310016, People's Republic of China
| | - Yue Ming
- Department of Anesthesiology and Pain Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88th, Hangzhou, 310016, People's Republic of China
| | - Xiaoling Yu
- Department of Anesthesiology and Pain Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88th, Hangzhou, 310016, People's Republic of China
| | - Lina Yu
- Department of Anesthesiology and Pain Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88th, Hangzhou, 310016, People's Republic of China
| | - Jiapeng Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY, 40202, USA
| | - Min Yan
- Department of Anesthesiology and Pain Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88th, Hangzhou, 310016, People's Republic of China. .,Department of Anesthesiology and Pain Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, NO, China.
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Abdullah T, Şentürk M. Positive End-Expiratory Pressure (PEEP), Tidal Volume, or
Alveolar Recruitment: Which One Does Matter in One-Lung Ventilation? CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00350-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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