Lung-protective ventilation and postoperative pulmonary complications during pulmonary resection in children: A prospective, single-centre, randomised controlled trial.

Autor: Zhu C; From the Department of Anesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (CZ, SZ, RW), Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China (CZ, MZ), Cardiothoracic Surgery Department, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (RZ)., Zhang M, Zhang S, Zhang R, Wei R
Jazyk: angličtina
Zdroj: European journal of anaesthesiology [Eur J Anaesthesiol] 2024 Dec 01; Vol. 41 (12), pp. 889-897. Date of Electronic Publication: 2024 Sep 05.
DOI: 10.1097/EJA.0000000000002063
Abstrakt: Background: Children are more susceptible to postoperative pulmonary complications (PPCs) due to their smaller functional residual capacity and higher closing volume; however, lung-protective ventilation (LPV) in children requiring one-lung ventilation (OLV) has been relatively underexplored.
Objectives: To evaluate the effects of LPV and driving pressure-guided ventilation on PPCs in children with OLV.
Design: Randomised, controlled, double-blind study.
Setting: Single-site tertiary hospital, 6 May 2022 to 31 August 2023.
Patients: 213 children aged < 6 years, planned for lung resection secondary to congenital cystic adenomatoid malformation.
Interventions: Children were randomly assigned to LPV ( n  = 142) or control ( n  = 71) groups. Children in LPV group were randomly assigned to either driving pressure group ( n  = 70) receiving individualised positive end-expiratory pressure (PEEP) to deliver the lowest driving pressure or to conventional protective ventilation group ( n  = 72) with fixed PEEP of 5 cmH 2 O.
Main Outcome Measures: The primary outcome was the incidence of PPCs within 7 days after surgery. Secondary outcomes were pulmonary mechanics, oxygenation and mechanical power.
Results: The incidence of PPCs did not differ between the LPV (24/142, 16.9%) and the control groups (15/71, 21.1%) ( P  = 0.45). The driving pressure was lower in the driving pressure group than in the 5 cmH 2 O PEEP group (15 vs. 17 cmH 2 O; P   =  0.001). Lung compliance and oxygenation were higher while the dynamic component of mechanical power was lower in the driving pressure group than in the 5 cmH 2 O PEEP group. The incidence of PPCs did not differ between the driving pressure (11/70, 15.7%) and the 5 cmH 2 O PEEP groups (13/72, 18.1%) ( P   =  0.71).
Conclusions: LPV did not decrease the occurrence of PPCs compared to non-protective ventilation. Although lung compliance and oxygenation were higher in the driving pressure group than in the 5 cmH 2 O PEEP group, these benefits did not translate into significant reductions in PPCs. However, the study is limited by a small sample size, which may affect the interpretation of the results. Future research with larger sample sizes is necessary to confirm these findings.
Trial Registration: ChiCTR2200059270.
(Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology.)
Databáze: MEDLINE
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