Postoperative Atelectasis in Pediatric Patients With Prone Position

Study Overview
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Brief Summary
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This study evaluates the incidence of postoperative atelectasis after general anesthesia with prone position using lung ultrasound in children age < 3 years.

Detailed Description
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Atelectasis is common in pediatric patients after general anesthesia. Particularly, infants are more likely to develop atelectasis or ventilation-perfusion imbalance after general anesthesia because of the immature ribs and respiratory muscles, the high compliance of the rib cage and a significant reduction in functional residual capacity (FRC) during general anesthesia. Previous studies have reported that alveolar recruitment and positive end-expiratory pressure (PEEP) can be used to reduce atelectasis in children. Also, previous studies have shown that the lung ultrasound can be used to evaluate the degree of atelectasis during general anesthesia in children. However, none of the previous studies investigated the incidence of atelectasis, the effect of alveolar recruitment, and the PEEP in pediatric patients under general anesthesia with prone position. The purpose of this study was to evaluate previously described parameters using lung ultrasound.

Official Title
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Postoperative Atelectasis in Pediatric Patients With Prone Position : Effect of Repetitive Alveolar Recruitment by Lung Ultrasound

Conditions
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Pulmonary Atelectasis, Postoperative, Atelectasis, Compression

Intervention / Treatment
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* Procedure: Repetitive recruitment with PEEP
* Procedure: One recruitment with PEEP


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children undergoing general anesthesia with prone position Endotracheal intubation and mechanical ventilation during general anesthesia Operation time is more than 2 hours Exclusion Criteria: Previous lung surgery Any abnormal findings such as atelectasis, pneumothorax, pleural effusion, or pneumonia on preoperative chest X-ray Researchers judge (to be inappropriate)

Ages Eligible for Study
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Maximum Age: 3 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Repetitive recruitment with PEEP<br>One alveolar recruitment at before surgery and repetitive alveolar recruitment (once an hour) during surgery | Procedure: Repetitive recruitment with PEEP<br>* Apply sustained airway pressure of 30-40 cmH2O for 10-20 seconds before suegery and once an hour during surgery. PEEP is set to 7 cmH2O.<br>|
| Active Comparator: One recruitment with PEEP<br>One alveolar recruitment at before surgery | Procedure: One recruitment with PEEP<br>* Apply sustained airway pressure of 30-40 cmH2O for 10-20 seconds before surgery. PEEP is set to 7 cmH2O.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of pre-extubation atelectasis | Incidence of pre-extubation atelectasis accessed by lung ultrasound | postoperative 10 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of intraoperative atelectasis after intubation | Incidence of intraoperative atelectasis after induction accessed by lung ultrasound | intraoperative | 
| Incidence of intraoperative atelectasis after position change to prone | Incidence of intraoperative atelectasis after position change to prone accessed by lung ultrasound | intraoperative | 
| Incidence of intraoperative and postoperative (within 12hr) desaturation | Oxygen saturation by pulse oximetry (SpO2) ≤ 95% or 10% below the baseline value | intraoperative and postoperative (within 12hr) | 
| Incidence of intraoperative hypotension | Systolic blood pressure (SBP) ≤ 20% below the baseline value | intraoperative |