Clinical trial NCT03141515: Sonographic Assessment of Postural Lung Recruitment in Pediatric Patients Under General Anesthesia
Official title: Sonographic Assessment of Postural Lung Recruitment in Pediatric Patients Under General Anesthesia
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Collapsed Lung
Keywords: lung ultrasound
recruitment maneuver
atelectasis
children
Lead sponsor: Hospital Privado de Comunidad de Mar del Plata
Sponsor class: OTHER
First posted: 2017-05-05
Enrollment: 40
Sex: ALL
Minimum age (years): 6
Maximum age (years): 5
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Anesthesia-induced atelectasis is a well-known entity observed in approximately 68-100% of pediatric patients undergoing general anesthesia. The collapse of dependent lung zones starts with anesthesia induction but can persist for hours or even days after surgery.

Lung collapse is a pressure-dependent phenomenon. Each acinus has a critical closing pressure, i.e., the minimum transpulmonary pressure (Ptp) below that the acinus begins to collapse. While airway pressure is homogeneously distributed within all lung units, Pleural pressure increases along the vertical gravitational vector because of the lung's weight. As a consequence, the decreased Ptp in the dependent zones promotes collapse. This means that patients in the supine position suffer from increasing closing pressures in the ventral to dorsal direction.

Alveolar recruitment maneuvers recruit collapsed alveoli, increase gas exchange, and improve arterial oxygenation.

The investigators hypothesized that in children with anesthesia-induced atelectasis, postural changes have recruiting effects and improve lung aeration assessed by lung ultrasound.

Detailed description: Compare lung aeration between two different lung recruitment strategies (recruitment maneuvers in supine position and recruitment maneuvers with postural changes of lateral decubitus with 10 cmH2O level of positive-end expiratory pressure (PEEP) during 180 seconds; in pediatric patients scheduled for surgery under general anesthesia using ultrasound imaging and a four-point-aeration score to assess the lung aeration.

Eligibility criteria: Inclusion Criteria:

* Written informed consent by parents.
* Patients aged 6 months to 5 years old
* Scheduled for surgery under general anesthesia with tracheal intubation with atelectasis assessed by lung ultrasound after anesthesia induction.
* American Society of Anesthesiologists classification: physical status I-II

Exclusion Criteria:

* Acute airway infection
* Cardiovascular or pulmonary disease
* Previous thoracic procedure

Primary outcomes:
measure: Lung aeration
timeFrame: Intraoperative
Secondary outcomes:
measure: Peripheral arterial oxygenation by pulse oximetry (SPO2%)
timeFrame: Intraoperative
measure: Respiratory mechanics
timeFrame: Intraoperative
Other outcomes:
Locations:
city: Mar del Plata
country: Argentina
facility: Cecilia M. Acosta
state: Buenos Aires
Study officials:
affiliation: Hospital Privado de Comunidad
name: Cecilia M Acosta, MD
role: PRINCIPAL_INVESTIGATOR
References: