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Effects of positive end-expiratory pressure on pulmonary atelectasis after paediatric laparoscopic surgery as assessed by ultrasound: A randomised controlled study

Authors
 Hye-Mi Lee  ;  Ji Young Min  ;  Jeong-Rim Lee  ;  Min Ho Lee  ;  Hyo-Jin Byon 
Citation
 ANAESTHESIA CRITICAL CARE & PAIN MEDICINE, Vol.41(2) : 101034, 2022-04 
Journal Title
ANAESTHESIA CRITICAL CARE & PAIN MEDICINE(Anaesth Crit Care Pain Med)
Issue Date
2022-04
Keywords
Anaesthesia-induced atelectasis ; Laparoscopic surgery ; Paediatrics ; Positive end-expiratory pressure (PEEP) ; Ultrasonography
Abstract
Introduction: Positive end-expiratory pressure (PEEP) following alveolar recruitment manoeuvre (RM) can effectively prevent anaesthesia-induced atelectasis in children. We aimed to evaluate the individual effect of PEEP following RM on atelectasis at the end of laparoscopic surgery in infants and small children.

Methods: Children undergoing laparoscopic inguinal hernia repair aged 5 weeks to 2 years were randomly allocated to either the PEEP or control group. A progressive RM was performed after intubation in all cases. The PEEP group received PEEP of 5 cmH2O until the end of mechanical ventilation, while the control group did not receive any PEEP. Lung ultrasonography was performed to compare the number of atelectatic regions between the two groups after anaesthesia induction, after RM, and at the end of surgery in 12 thoracic regions.

Results: Overall, 432 ultrasonographic images were acquired from 36 children. At the end of surgery, the number of atelectatic regions (median [interquartile range]) was significantly lower in the PEEP group compared to the control group (2.0 [1.0-3.0] versus 4.0 [3.0-4.0] out of 12 regions, respectively; p = 0.02). While no difference was observed between the number of atelectatic regions after induction and at the end of surgery in the control group (p = 0.30), a decrease was observed in the PEEP group (3.0 [2.0-4.0] to 2.0 [1.0-3.0], respectively; p = 0.02).

Conclusion: RM followed by a PEEP of 5 cmH2O can effectively reduce the regions of pulmonary atelectasis at the end of laparoscopic surgery in infants and small children.
Full Text
https://www.sciencedirect.com/science/article/pii/S2352556822000157
DOI
10.1016/j.accpm.2022.101034
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Byon, Hyo Jin(변효진)
Lee, Jeong Rim(이정림) ORCID logo https://orcid.org/0000-0002-7425-0462
Lee, Hye Mi(이혜미) ORCID logo https://orcid.org/0000-0002-0432-1878
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/188263
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