Lung Recruitment Maneuver as a Potential Predictor of Fluid Responsiveness in Mechanically Ventilated Pediatric Patients

Study Overview
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Brief Summary
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In this research study we want to learn more about using non-invasive tools as a way to predict whether or not a child under general anesthesia will require and respond to fluid administration. It is important for an anesthesiologist to know if a child would respond to fluid administration so that they can provide the optimal intervention for low blood pressure and avoid unnecessary treatment.

Detailed Description
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In this research study we want to learn more about using non-invasive tools as a way to predict whether or not a child under general anesthesia will require and respond to fluid administration. It is important for an anesthesiologist to know if a child would respond to fluid administration so that they can provide the optimal intervention for low blood pressure and avoid unnecessary treatment.

Official Title
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Lung Recruitment Maneuver as a Potential Predictor of Fluid Responsiveness in Mechanically Ventilated Pediatric Patients

Conditions
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Anesthesia, Intravenous Fluid, Blood Pressure

Intervention / Treatment
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* Other: Lung Recruitment Maneuver
* Other: Fluid Administration


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 0 to < 18 years old Undergoing surgery at Boston Children's Hospital under general anesthesia mechanically ventilated with an endotracheal tube Monitored with an indwelling radial arterial catheter as part of the anesthetic plan for the scheduled surgical procedure Exclusion Criteria: Prematurity Low birth weight Congenital heart disease Left or right ventricular dysfunction Cardiac arrhythmia Pulmonary hypertension Preoperative parenchymal or interstitial lung disease Intracranial hypertension Poor transthoracic acoustic window Obesity Allergy to ultrasound transmission gel Need for single lung ventilation Systemic hypertension on antihypertensive medications

Ages Eligible for Study
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Maximum Age: 17 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Surgical patients less than 18 years old<br>Patients less than 18 years old having surgery with general anesthesia at Boston Children's Hospital | Other: Lung Recruitment Maneuver<br>* Lung Recruitment Maneuver by Anesthesiologist<br>Other: Fluid Administration<br>* Administration of IV Fluid by Anesthesiologist<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in stroke volume | Evaluate Lung Recruitment Maneuver as a means to predict fluid responsiveness in mechanically ventilated pediatric patients in the operating room. | immediately before and after each intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in arterial compliance effect on Systolic Pressure Variation (mmHg) | Evaluate the effect of arterial stiffness on Systolic Pressure Variation (mmHg) in mechanically ventilated pediatric patients in the operating room. | immediately before and after each intervention | 
| Change in arterial compliance effect on Pulse Pressure Variation (%) | Evaluate the effect of arterial stiffness on Pulse Pressure Variation (%) in mechanically ventilated pediatric patients in the operating room. | immediately before and after each intervention | 
| Change in arterial compliance effect on Plethysmographic Variability Index (%) | Evaluate the effect of arterial stiffness on Plethysmographic Variability Index (%) in mechanically ventilated pediatric patients in the operating room. | immediately before and after each intervention |