Effectiveness of Ultrasound-guided Lung Ventilation in Determining the Optimum Inspiratory Pressure in Pediatric Patients
Condition: Pediatric Lung Atelectasis
MeSH terms: Pulmonary Atelectasis
Study type: Interventional

Summary: 
      This study aimed to show the Effectiveness of Ultrasound-guided Lung Ventilation to determine
      the appropriate level of inspiratory pressure sufficient to provide adequate pulmonary
      ventilation with the resolution of the atelectatic lung.
    

Detailed description: 
      Respiratory physiology is different in young children, especially in neonates and infants,
      from that of older children and adults. Neonates and infants have immature respiratory
      control, weak respiratory muscles, different airways, lung mechanics and higher basal
      metabolic oxygen requirements. Appreciating these distinctive respiratory characteristics in
      young children is necessary to formulate suitable anesthetic plans for the safe conduct of
      anesthesia as respiratory-related morbidity and mortality occur even in healthy children.

      Atelectasis is a side effect of general anesthesia which can be found in all types of
      interventions and patients of all ages. The reported incidence of anesthesia-induced
      atelectasis in children varies from 12 to 42% in sedated and non-intubated patients and from
      68 to 100% in children with general anesthesia with tracheal intubation or laryngeal mask.

      Such lung collapse causes arterial blood oxygenation to decline during and after anesthesia.
      Although anesthesia-induced atelectasis resolves spontaneously in children with American
      Society of Anesthesiology's (ASA) physical status classification I to II after minor surgical
      procedures, this entity may persist in the postoperative period in high-risk children
      undergoing complex surgeries. In the latter population, atelectasis potentially increases the
      risk for ventilator-induced lung injury and could be associated with postoperative pulmonary
      complications.

      Atelectasis and poorly ventilated lung areas appear during general anesthesia in adults as
      well as in children. It is of concern that collapsed lung tissue reduces lung compliance and
      causes venous admixture and arterial oxygenation impairment. Despite its high prevalence
      during anesthesia, bedside diagnosis of atelectasis remains challenging. Anesthesia-induced
      atelectasis is commonly small and thus mostly invisible on standard chest radiographs. In
      contrast, it can easily be diagnosed by tomographic imaging techniques such as computed
      tomography or magnetic resonance imaging (MRI). However, these latter are clinically
      impractical, expensive, time-consuming, and with harmful exposition to x-ray.

      Sonography is a simple, non-invasive, and radiation-free methodology that has increased daily
      practice usage. Lung sonography (LUS) plays an important role in diagnosing pulmonary
      diseases in children, including obstructive and compressive atelectasis of different origins.
      Just as in adults, LUS could identify children needing a recruitment maneuver to re-expand
      their lungs and help optimize ventilator treatment during anesthesia. LUS could also identify
      critically ill children with a high risk for developing pulmonary complications due to
      residual atelectasis after surgery.

      A prospective, randomized, double-blind study in the Second Affiliated Hospital and Yuying
      Children Hospital of Wenzhou Medical University showed that an inspiratory pressure of 12 cm
      H2O was sufficient to provide adequate ventilation with a lower occurrence of gastric
      insufflation during induction of general anesthesia in paralyzed Chinese children aged from 2
      to 4 years old.

      Many studies used LUS to determine the optimum positive end-expiratory pressure (PEEP), yet
      no previous studies used LUS to determine the best inspiratory pressure (IP) for pressure
      controlled ventilation. So, this study aimed to determine the appropriate level of
      inspiratory pressure sufficient to provide adequate pulmonary ventilation with the resolution
      of anesthesia-induced lung atelectasis using real-time ultrasonography in paralyzed children.
    

Intervention name(s): Increasing the inspiratory pressure if atelectasis detected by US
Intervention type(s): Procedure
Intervention description(s): The study used US to detect presence of lung atelectasis under mechanical ventilation in pediatrics. Inspiratory pressure increased gradually with continuous monitoring by lung US to minimize the atelectasis as possible.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This is a comparative prospective randomized controlled study.
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Prevention