Ultrasonographic Assessment of Lung Recruitment Maneuvers in Children Undergoing Lengthy Microsurgery Operations
Condition: Intraoperative Complications
MeSH terms: Intraoperative Complications
Study type: Interventional

Summary: 
      The aim of this study will be to explore the clinical value of ultrasonic monitoring in the
      diagnosis of anesthesia-induced atelectasis, the assessment of the effects of lung
      recruitment, the best positive end-expiratory pressure (PEEP) after RM and in the detection
      of the point of lung re-collapse after RM in pediatric patients undergoing lengthy
      microsurgery operations using two levels of intraoperative FIO2 (0.5 VERSUS 0.3).
    

Detailed description: 
      -  To maximize the benefits, minimize the drawbacks and assess the adequacy of the
           recruitment maneuver; adequate monitoring at the bedside is essential. Several methods
           have been proposed, including measuring end-expiratory lung volume or pulmonary
           compliance, volumetric capnography, oxygenation indices, electrical impedance
           tomography, computerized tomography and lung ultrasound.

        -  For lung CT examination patients must be transported out to the radiation unit, which
           carries risk of transfer, high cost, and radiation exposure. The oxygenation method
           which is the most commonly used, but it is necessary to repeat arterial blood collection
           many times, which is cumbersome and expensive.

        -  Using lung ultrasound (LUS) as real-time guidance during the recruitment maneuver has
           gained popularity recently owing to its' easy applicability and non-invasive nature.
           Sonography is a radiation-free methodology which plays an important role in diagnosing
           pulmonary diseases in children, including obstructive and compressive atelectasis of
           different origins. Furthermore, lung ultrasound has shown reliable sensitivity and
           specificity for the diagnosis of anaesthesia-induced atelectasis in children.

        -  LUS can identify children needing a recruitment maneuver to re-expand their lungs and
           help optimize ventilator treatment during anesthesia.
    

Intervention name(s): RM 0.5; RM 0.3
Intervention type(s): Device; Device
Intervention description(s): Patients will receive recruitment maneuver (RM) followed by decremental PEEP titration 1min. after establishment of mechanical ventilation and after documented lung re-collapse.; The patient will be ventilated with volume control mode with tidal volume 6 ml/kg, PEEP 3 cmH2O, an inspiratory expiratory ratio of 1:1.5, respiratory rate 20-25 breaths per minute depending on the patient's age and FiO2 of 0.3.
Other intervention name(s): RM; RM
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: To explore the clinical value of ultrasonic monitoring in the diagnosis of anesthesia-induced atelectasis, the assessment of the effects of lung recruitment, the best positive end-expiratory pressure (PEEP) after RM and in the detection of the point of lung re-collapse after RM in pediatric patients undergoing lengthy microsurgery operations using two levels of intraoperative FIO2 (0.5 VERSUS 0.3).
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment