Clinical trial NCT05777018: Ultrasound-guided Lung Recruitment Maneuvers for Postoperative Pediatric Atelectasis
Official title: Safety and Efficacy of Ultrasound Guided Lung Recruitment Maneuvers for Prevention of Postoperative Atelectasis After Pediatric Laparoscopic Abdominal Surgery: A Prospective Randomized Study
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Atelectasis
Postoperative Complications
Recruitment
Pediatric
Abdominal Surgery
Lead sponsor: Tanta University
Sponsor class: OTHER
First posted: 2023-03-20
Enrollment: 90
Sex: ALL
Minimum age (years): 1
Maximum age (years): 6
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: In anesthetized children, the incidence of lung collapse with episodes of hypoxemia is high. Diaphragmatic dysfunction induced by general anesthesia is one of the most important factors in the genesis of regional losses of lung aeration. The mass of the abdominal organs pushes the diaphragm cranially compressing the lungs in the most dependent areas. Such regional lung collapse may range from a slight loss of aeration to complete atelectasis.

Detailed description: A wide variety of recruitment maneuvers has been described. The most relevant are represented by sustained inflation maneuvers, high pressure-controlled ventilation, incremental PEEP, and intermittent sighs. However, the best recruitment maneuver technique is currently unknown and may vary according to the specific circumstances. The most commonly used recruitment maneuver is the sustained inflation technique, in which a continuous pressure of 40 cm H2O is applied to the airways for up to 60 seconds. Sustained inflation has been shown to be effective in reducing lung atelectasis, improving oxygenation and respiratory mechanics, and preventing endotracheal suctioning-induced alveolar derecruitment. However, the efficacy of sustained inflation has been questioned and other studies showed that this intervention may be ineffective, short-lived, or associated with circulatory impairment, an increased risk of baro/volutrauma, a reduced net alveolar fluid clearance, or even worsened oxygenation.

Lung ultrasound has been gaining consensus as a noninvasive, radiation-free tool for diagnosing various pulmonary diseases in adult and pediatric patients. Evidence supporting lung ultrasound use is expanding beyond emergency and critical care settings to perioperative care.

It has been reported that lung ultrasound (LUS) at a patient's bedside immediately following surgery can be useful for diagnosing respiratory complications. LUS has been proven to be a valuable bedside diagnostic tool for pneumothorax, with high sensitivity and specificity (78.6% and 98.4%, respectively), and a higher rate of detecting abnormalities such as lung alveolar consolidation and pleural effusion than bedside chest X-ray or physical examination. LUS has also been used to diagnose anesthesia-induced atelectasis in pediatric patients.

Eligibility criteria: Inclusion Criteria:

* Patients scheduled for laparoscopic abdominal surgery
* American Society of anaesthesiologist class I \& II

Exclusion Criteria:

* Pre-existing cardiac disease.
* Morbidly obese patients according to age.
* Patients with previous thoracic or cardiac surgery.
* Upper or lower airway infection within 2 weeks before the surgery.
* Lung ultrasound abnormalities including patches, pneumothorax, and pleural effusion.
* Abnormal preoperative chest x-ray findings including atelectasis, pneumothorax, pleural effusion or pneumonia.
* Preoperative oxygen saturation measured by pulse oximetry (SpO2) of 96% or less on room air.

Primary outcomes:
measure: The incidence of atelectasis
timeFrame: postoperative first 2 hours
Secondary outcomes:
Other outcomes:
Locations:
city: Tanta
country: Egypt
facility: Faculty of medicine, Tanta university
state: El Gharbyia
Study officials:
affiliation: tanta university, faculty of medicine
name: hoda ezz
role: PRINCIPAL_INVESTIGATOR
References: