Ultrasound-guided versus conventional lung recruitment manoeuvres in laparoscopic gynaecological surgery: A randomised controlled trial.
Eur J Anaesthesiol
; 38(3): 275-284, 2021 Mar 01.
Article
em En
| MEDLINE
| ID: mdl-33399385
ABSTRACT
BACKGROUND:
Pneumoperitoneum and steep Trendelenburg position promote the formation of pulmonary atelectasis during laparoscopic gynaecological surgery.OBJECTIVE:
To determine whether lung ultrasound-guided alveolar recruitment manoeuvres could reduce peri-operative atelectasis compared with conventional recruitment manoeuvres during laparoscopic gynaecological surgery.DESIGN:
Randomised controlled trial.SETTING:
Tertiary hospital, Republic of Korea, from August 2018 to January 2019. PATIENTS Adult patients scheduled for laparoscopic gynaecological surgery under general anaesthesia. INTERVENTION Forty patients were randomised to receive either ultrasound-guided recruitment manoeuvres (manual inflation until no visibly collapsed area was seen with lung ultrasonography; intervention group) or conventional recruitment manoeuvres (single manual inflation with 30âcmH2O pressure; control group). Recruitment manoeuvres were performed 5âmin after induction and at the end of surgery in both groups. All patients received volume-controlled ventilation with a tidal volume of 8âmlâkg-1 and a positive end-expiratory pressure of 5âcmH2O. MAIN OUTCOMEMEASURES:
The primary outcome was the lung ultrasound score at the end of surgery; a higher score indicates worse lung aeration.RESULTS:
Lung ultrasound scores at the end of surgery were significantly lower in the intervention group compared with control group (median [IQR], 7.5 [6.5 to 8.5] versus 9.5 [8.5 to 13.5]; difference, -2 [95% CI, -4.5 to -1]; Pâ=â0.008). The intergroup difference persisted in the postanaesthesia care unit (7 [5 to 8.8] versus 10 [7.3 to 12.8]; difference, -3 [95% CI, -5.5 to -1.5]; Pâ=â0.005). The incidence of atelectasis was lower in the intervention group compared with control group at the end of surgery (35 versus 80%; Pâ=â0.010) but was comparable in the postanaesthesia care unit (40 versus 55%; Pâ=â0.527).CONCLUSIONS:
The use of ultrasound-guided recruitment manoeuvres improves peri-operative lung aeration; these effects may persist in the postanaesthesia care unit. However, the long-term effects of ultrasound-guided recruitment manoeuvres on clinical outcomes should be the subject of future trials. TRIAL REGISTRATION ClinicalTrials.gov (NCT03607240).
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Laparoscopia
/
Pulmão
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Guideline
Limite:
Adult
/
Female
/
Humans
País/Região como assunto:
Asia
Idioma:
En
Revista:
Eur J Anaesthesiol
Assunto da revista:
ANESTESIOLOGIA
Ano de publicação:
2021
Tipo de documento:
Article