Lung ultrasound evaluation of incremental PEEP recruitment maneuver in children undergoing cardiac surgery

Abstract

Aim To explore the effect of incremental positive end‐expiratory pressure recruitment maneuver (iPEEPRM) in children with congenital heart diseases (CHDs) using lung ultrasound. Methods Thirty‐six children aged 3 months to 5 years scheduled for cardiac surgery participated. iPEEPRM was performed with PEEP stepwise increase (0‐5‐10‐15 cmH2O) and decrease at the same rate before and after surgery. Atelectatic areas, ultrasound scores, arterial oxygen pressure (PaO2), and respiratory system dynamic compliance per kilogram body weight (CDyn/kg) were analyzed before and after iPEEPRM. The primary outcome is the incidence of atelectasis. Secondary outcomes are oxygenation, ventilation, CDyn/kg, and atelectasis area. Results iPEEPRM was successfully applied in 92% (33/36) children before surgery and 71% (24/34) children after surgery. The incidence of atelectasis was significantly reduced by iPEEPRM from 76% to 15% before surgery and from 92% to 38% after surgery, respectively (P < .001). Before surgery, iPEEPRM significantly reduced atelectatic areas and ultrasound scores: 32.5 (0‐128.1) mm2 vs 0 (0‐0) mm2 and 8 (3‐12) vs 2 (0‐4). PaO2 and CDyn/kg were significantly increased after iPEEPRM: 243 (129‐275) mm Hg vs 278 (207‐323) mm Hg and 0.6 (0.4‐0.7) mL/cmH2O/kg vs 0.8 (0.6‐1.0) mL/cmH2O/kg. After surgery, iPEEPRM significantly reduced atelectatic areas and ultrasound scores: 45.7 (13.1‐115.8) mm2 vs 0 (0‐34.7) mm2, and 9 (6‐12) vs 3 (0‐5). PaO2 and CDyn/kg were also significantly increased after iPEEPRM. Conclusions iPEEPRM effectively reduced atelectasis, improved lung aeration, oxygenation, and CDyn/kg in children undergoing cardiac surgery.

Effectiveness of postural lung recruitment on postoperative atelectasis assessed by lung ultrasound in children undergoing lateral thoracotomy cardiac surgery with cardiopulmonary bypass

“…It is crucial to closely monitor the patient immediately after completion of the cardiac surgery for the unexpected hemodynamic swings 15,21 . Our previous study 15 revealed that a higher incidence of hemodynamic repercussions was found when 10 breaths (20–30 s) were maintained at each step. In the study by Song et al, 7 there were no severe hemodynamic events recorded if PEEP was held at each level only for 5 s during RM.…”

“…Hemodynamic events were recorded and defined as ≥20% changes from baseline. The atelectatic areas were measured using ImageJ version 1.31 (Mac OS X; National Institutes of Health) 14,15 …”

“…The atelectatic areas were measured using ImageJ version 1.31 (Mac OS X; National Institutes of Health). 14,15 As there were no previous studies available about the incidence of lung atelectasis in children undergoing lateral thoracotomy cardiac surgery, we calculated the sample size in reference to a few other studies in pediatric patients. One study demonstrated 16 that the incidence of atelectasis in children undergoing magnetic resonance imaging under general anesthesia was 94% before emergence and another study 7 found that the incidence was 80% detected by ultrasound in children undergoing heart surgery.…”

Lung Ultrasound Scans During Whole Lung Lavage

“…Use of POCUS to guide recruitment maneuvers in pediatric surgery patients with atelectatic lung has also been reported recently. 7,8 We also perform a bilateral lung ultrasound examination prior to extubation and discharge from the recovery room. This confirms lung sliding or B-lines (rule-out pneumothorax) and identifies residual atelectasis or effusion that may need intervention.…”

Effects of Small-Dose S-Ketamine On Anesthesia-Induced Atelectasis In Patients Undergoing General Anesthesia Accessed By Lung Ultrasound: Study Protocol For A Randomized, Double-Blinded Controlled Trial

“…A well-trained blinded anesthesiologist will perform all lung ultrasound scans using SonoSite M-Turbo with a 5-12 MHz linear transducer. Patients will be scanned in the supine position following the lung ultrasound method described by Sun et al [39]. Brie y, six regions will be scanned in each hemithorax.…”