Lung recruitment prevents collapse during laparoscopy in children

Acosta, Cecilia; Sara, Tomás; Carpinella, Martín; Volpicelli, Giovanni; Ricci, Lorenzo; Poliotto, Sergio; Abrego, Diego; Gonorazky, Sergio Eduardo; Böhm, Stephan H.; Tusman, Gerardo

doi:10.1097/eja.0000000000000761

Cited by 42 publications

(75 citation statements)

References 31 publications

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“…18 Therefore, all strategies to pre- conducted both in adults and in children. 2,11,21 In the current study, children were overly exposed to lung de-recruitment (use of ZEEP or low level of PEEP, high FiO 2 , extubation while apply suctioning) and only 20% of the intubated patients received recruitment maneuvers. 22 Habre et al recommend to set the FiO 2 at 80% during emergence in children as a compromise between the consequences of high FiO 2 and the increased risk of desaturation in younger children.…”

Section: Discussionmentioning

confidence: 99%

“…These experts in pediatric mechanical ventilation nowadays recommend the following: avoidance of a high tidal volume, monitoring expired tidal volume and end-tidal CO 2 (EtCO 2 ) and using a low inspired fraction of oxygen (FiO 2 ), a positive end-expiratory pressure (PEEP), and recruitment maneuvers, but also avoidance of unnecessary tracheal suction in order to prevent atelectasis formation (see Appendix B). [5][6][7][8][9][10][11] In the absence of a high level of evidence for optimal ventilation criteria in anesthetized children with healthy lungs, the aim of the present study was to assess current ventilatory management practice during pediatric anesthesia in France, looking specifically at the parameters defined in the above-mentioned expert statements and with a specific focus on tidal volume.…”

Section: Introductionmentioning

confidence: 99%

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Ventilation in pediatric anesthesia: A French multicenter prospective observational study (PEDIAVENT)

Lebossé

Kern

Queiroz

et al. 2020

Pediatric Anesthesia

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Introduction Protective ventilation is now a standard of care in adults. However, management of ventilation is heterogeneous in children and little is known regarding the mechanical ventilation parameters actually used during pediatric anesthesia. Aim The aim of the study was to assess current ventilatory practices during pediatric anesthesia in France and to compare them with pediatric experts' statements, with a specific focus on tidal volume. Patients and methods We conducted a prospective multicenter observational study, regarding the ventilatory management and the mechanical ventilation parameters, over two days (21 and 22 June 2017) in 29 pediatric centers in France. All children undergoing general anesthesia during these 2 days were eligible; those who required extracorporeal circulation or one‐lung ventilation were excluded. Results A total of 701 children were included; median [IQR] age was 60 [24‐120] months. Among the patients in whom controlled ventilation was used, 254/515 (49.3%) had an expired tidal volume >8 mL/kg and 44 children (8.8%) an expired tidal volume ≥10 mL/kg. Lower weight and use of a supraglottic airway device were significantly associated with provision of a tidal volume ≥10 mL/kg (odds ratio 0.94, 95% confidence interval [0.92; 0.97], P < .001 and 2.28 [1.20; 4.31], P = .012, respectively). The positive end‐expiratory pressure was set at a median [IQR] of 4 [3‐5] cmH2O; it was <3 cmH2O in 15.7% of children and not used in 56/499 (9.3%). Among intubated children, 57 (18.3%) received a tidal volume < 10 mL/kg with a positive end‐expiratory pressure ≥3 cmH2O in association with recruitment maneuvers. Conclusions Ventilatory practices in children were heterogenous, and a large proportion of children were not ventilated as it is currently recommended by some experts.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ventilation in pediatric anesthesia: A French multicenter prospective observational study (PEDIAVENT)

Lebossé

Kern

Queiroz

et al. 2020

Pediatric Anesthesia

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“…They concluded that a more aggressive PEEP level is required to reduce shunt and to normalize respiratory compliance during laparoscopic surgery because of the reduction of FRC caused by the pneumoperitoneum . Acosta et al suggested that PEEP levels higher than the usual 5 cmH 2 O would be required to preserve normal lung aeration during pneumoperitoneum in pediatric laparoscopic surgeries . However, these higher levels of PEEP must be matched with the patients' hemodynamics that appear to be more sensitive to airway pressure than in adults .…”

Section: Discussionmentioning

confidence: 65%

Post‐extubation continuous positive airway pressure improves oxygenation after pediatric laparoscopic surgery: A randomized controlled trial

Abdel‐Ghaffar

Youseff

Abdelal

et al. 2019

Acta Anaesthesiol Scand

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Background: Effects of intraoperative recruitment maneuvers (RMs) on oxygenation and pulmonary compliance are lost during recovery if high inspired oxygen and airway suctioning are used. We investigated the effect of post-extubation noninvasive CPAP mask application on the alveolar arterial oxygen difference [(A-a) DO 2 ] after pediatric laparoscopic surgery. Methods: Sixty patients (1-6 years) were randomly allocated to three groups of 20 patients, to receive zero end-expiratory pressure (ZEEP group), RM with decremental PEEP titration only (RM group), or followed with post-extubation CPAP for 5 minutes (RM-CPAP group). Primary outcome was [(A-a) DO 2 ] at 1 hour postoperatively. Secondary outcomes were respiratory mechanics, arterial blood gas analysis, hemodynamics, and adverse events. Results: At 1 hour postoperatively, mean [(A-a) DO 2 ] (mm Hg) was lower in the RM-CPAP group (41.5 ± 13.2, [95% CI 37.6-45.8]) compared to (80.2 ± 13.7 [72.6-87.5], P < 0.0001] and (59.2 ± 14.6, [54.8-62.6], P < 0.001) in the ZEEP and RM groups. The mean PaO 2 (mm Hg) at 1 hour postoperatively was higher in the RM-CPAP group (156.2 ± 18.3 [95% CI 147.6-164.7]) compared with the ZEEP (95.9 ± 15.9 [88.5-103.3], P < 0.0001) and RM groups (129.1 ± 15.9 [121.6-136.5], P < 0.0001). At 12 hours postoperatively, mean [(A-a) DO 2 ] and PaO 2 were (9.6 ± 2.1 [8.4-10.8]) and (91.9 ± 9.4[87.5-96.3]) in the RM-CPAP group compared to (25.8 ± 5.5 [23.6-27.6]) and (69.9 ± 5.5 [67.4-72.5], P < 0.0001) in the ZEEP group and (34.3 ± 13.2, [28.4-40.2], P < 0.0001) and (74.03 ± 9.8 [69.5-78.6], P < 0.0001) in the RM group. No significant differences of perioperative adverse effects were found between groups. Conclusions:An RM done after pneumoperitoneum inflation followed by decremental PEEP titration improved oxygenation at 1 hour postoperatively. The addition of an early post-extubation noninvasive CPAP mask ventilation improved oxygenation at 12 hours postoperatively.

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“…A decrease in R5 suggests an improved Cdyn. Although the effect of ARMs on lung compliance is controversial [13], many studies have reported a statistically significant increase in lung compliance after ARMs in patients undergoing surgery [2,[12][13][14][15]. We hypothesized that respiratory resistance would be a better parameter for measuring the effects of ARMs in patients with intact respiratory systems; however, this hypothesis was incorrect.…”

Section: Discussionmentioning

confidence: 98%

“…Using recruitment maneuvers to open the lungs improves the effectiveness of PEEP for gas exchange during mechanical ventilation [9][10][11]. Although many studies have reported the effectiveness of low tidal volume ventilation and ARMs [2][3][4][12][13][14][15], no studies have evaluated ARMs independently of the PEEP level [16]. The definition of ARMs varies among studies.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of alveolar recruitment maneuver on respiratory resistance during general anesthesia: a prospective observational study

2020

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Background Alveolar recruitment maneuvers enable easily reopening nonaerated lung regions via a transient elevation in transpulmonary pressure. To evaluate the effect of these maneuvers on respiratory resistance, we used an oscillatory technique during mechanical ventilation. This study was conducted to assess the effect of the alveolar recruitment maneuvers on respiratory resistance under routine anesthesia. We hypothesized that respiratory resistance at 5 Hz (R5) after the maneuver would be decreased after the lung aeration. Methods After receiving the ethics committee’s approval, we enrolled 33 patients who were classified with an American Society of Anesthesiologists physical status of 1, 2 or 3 and were undergoing general anesthesia for transurethral resection of a bladder tumor within a 12-month period from 2017 to 2018. The recruitment maneuver was performed 30 min after endotracheal intubation. The maneuver consisted of sustained manual inflation of the anesthesia reservoir bag to a peak inspiratory pressure of 40 cmH2O for 15 s, including 5 s of gradually increasing the peak inspiratory pressure. Respiratory resistance was measured using the forced oscillation technique before and after the maneuver, and the mean R5 was calculated during the expiratory phase. The respiratory resistance and ventilator parameter results were analyzed using paired Student’s t-tests, and p < 0.05 was considered statistically significant. Results We analyzed 31 patients (25 men and 6 women). R5 was 7.3 ± 1.6 cmH2O/L/sec before the recruitment maneuver during mechanical ventilation and was significantly decreased to 6.4 ± 1.7 cmH2O/L/sec after the maneuver. Peak inspiratory pressure and plateau pressure were significantly decreased, and pulmonary compliance was increased, although the values were not clinically relevant. Conclusion The recruitment maneuver decreased respiratory resistance and increased lung compliance during mechanical ventilation. Trial registration Name of registry: Japan Medical Association Center for Clinical Trials. Trial registration number: reference JMA-IIA00136. Date of registration: 2 September 2013. URL of trial registry record: https://dbcentre3.jmacct.med.or.jp/JMACTR/App/JMACTRE02_04/JMACTRE02_04.aspx?kbn=3&seqno=3582

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Lung recruitment prevents collapse during laparoscopy in children

Abstract: NCT02824146.

Cited by 42 publications

References 31 publications

Ventilation in pediatric anesthesia: A French multicenter prospective observational study (PEDIAVENT)

Ventilation in pediatric anesthesia: A French multicenter prospective observational study (PEDIAVENT)

Post‐extubation continuous positive airway pressure improves oxygenation after pediatric laparoscopic surgery: A randomized controlled trial

Evaluation of alveolar recruitment maneuver on respiratory resistance during general anesthesia: a prospective observational study

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