Cargando…
Effect of sigh in lateral position on postoperative atelectasis in adults assessed by lung ultrasound: a randomized, controlled trial
BACKGROUND: Postoperative atelectasis occurs in 90% of patients receiving general anesthesia. Recruitment maneuvers (RMs) are not always effective and frequently associated with barotrauma and hemodynamic instability. It is reported that many natural physiological behaviors interrupted under general...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9275275/ https://www.ncbi.nlm.nih.gov/pubmed/35820814 http://dx.doi.org/10.1186/s12871-022-01748-9 |
_version_ | 1784745455507210240 |
---|---|
author | Li, Caifeng Ren, Qian Li, Xin Han, Hongqiu Peng, Min Xie, Keliang Wang, Zhiqiang Wang, Guolin |
author_facet | Li, Caifeng Ren, Qian Li, Xin Han, Hongqiu Peng, Min Xie, Keliang Wang, Zhiqiang Wang, Guolin |
author_sort | Li, Caifeng |
collection | PubMed |
description | BACKGROUND: Postoperative atelectasis occurs in 90% of patients receiving general anesthesia. Recruitment maneuvers (RMs) are not always effective and frequently associated with barotrauma and hemodynamic instability. It is reported that many natural physiological behaviors interrupted under general anesthesia could prevent atelectasis and restore lung aeration. This study aimed to find out whether a combined physiological recruitment maneuver (CPRM), sigh in lateral position, could reduce postoperative atelectasis using lung ultrasound (LUS). METHODS: We conducted a prospective, randomized, controlled trial in adults with open abdominal surgery under general anesthesia lasting for 2 h or longer. Subjects were randomly allocated to either control group (C-group) or CPRM-group and received volume-controlled ventilation with the same ventilator settings. Patients in CPRM group was ventilated in sequential lateral position, with the addition of periodic sighs to recruit the lung. LUS scores, dynamic compliance (Cdyn), the partial pressure of arterial oxygen (PaO(2)) and fraction of inspired oxygen (FiO(2)) ratio (PaO(2)/FiO(2)), and other explanatory variables were acquired from each patient before and after recruitment. RESULTS: Seventy patients were included in the analysis. Before recruitment, there was no significant difference in LUS scores, Cdyn and PaO(2)/FiO(2) between CPRM-group and C-group. After recruitment, LUS scores in CPRM-group decreased significantly compared with C-group (6.00 [5.00, 7.00] vs. 8.00 [7.00, 9.00], p = 4.463e-11 < 0.05), while PaO(2)/FiO(2) and Cdyn in CPRM-group increased significantly compared with C-group respectively (377.92 (93.73) vs. 309.19 (92.98), p = 0.008 < 0.05, and 52.00 [47.00, 60.00] vs. 47.70 [41.00, 59.50], p = 6.325e-07 < 0.05). No hemodynamic instability, detectable barotrauma or position-related complications were encountered. CONCLUSIONS: Sigh in lateral position can effectively reduce postoperative atelectasis even without causing severe side effects. Further large-scale studies are necessary to evaluate it’s long-term effects on pulmonary complications and hospital length of stay. TRIAL REGISTRATION: ChiCTR1900024379. Registered 8 July 2019, SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12871-022-01748-9. |
format | Online Article Text |
id | pubmed-9275275 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-92752752022-07-13 Effect of sigh in lateral position on postoperative atelectasis in adults assessed by lung ultrasound: a randomized, controlled trial Li, Caifeng Ren, Qian Li, Xin Han, Hongqiu Peng, Min Xie, Keliang Wang, Zhiqiang Wang, Guolin BMC Anesthesiol Research BACKGROUND: Postoperative atelectasis occurs in 90% of patients receiving general anesthesia. Recruitment maneuvers (RMs) are not always effective and frequently associated with barotrauma and hemodynamic instability. It is reported that many natural physiological behaviors interrupted under general anesthesia could prevent atelectasis and restore lung aeration. This study aimed to find out whether a combined physiological recruitment maneuver (CPRM), sigh in lateral position, could reduce postoperative atelectasis using lung ultrasound (LUS). METHODS: We conducted a prospective, randomized, controlled trial in adults with open abdominal surgery under general anesthesia lasting for 2 h or longer. Subjects were randomly allocated to either control group (C-group) or CPRM-group and received volume-controlled ventilation with the same ventilator settings. Patients in CPRM group was ventilated in sequential lateral position, with the addition of periodic sighs to recruit the lung. LUS scores, dynamic compliance (Cdyn), the partial pressure of arterial oxygen (PaO(2)) and fraction of inspired oxygen (FiO(2)) ratio (PaO(2)/FiO(2)), and other explanatory variables were acquired from each patient before and after recruitment. RESULTS: Seventy patients were included in the analysis. Before recruitment, there was no significant difference in LUS scores, Cdyn and PaO(2)/FiO(2) between CPRM-group and C-group. After recruitment, LUS scores in CPRM-group decreased significantly compared with C-group (6.00 [5.00, 7.00] vs. 8.00 [7.00, 9.00], p = 4.463e-11 < 0.05), while PaO(2)/FiO(2) and Cdyn in CPRM-group increased significantly compared with C-group respectively (377.92 (93.73) vs. 309.19 (92.98), p = 0.008 < 0.05, and 52.00 [47.00, 60.00] vs. 47.70 [41.00, 59.50], p = 6.325e-07 < 0.05). No hemodynamic instability, detectable barotrauma or position-related complications were encountered. CONCLUSIONS: Sigh in lateral position can effectively reduce postoperative atelectasis even without causing severe side effects. Further large-scale studies are necessary to evaluate it’s long-term effects on pulmonary complications and hospital length of stay. TRIAL REGISTRATION: ChiCTR1900024379. Registered 8 July 2019, SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12871-022-01748-9. BioMed Central 2022-07-11 /pmc/articles/PMC9275275/ /pubmed/35820814 http://dx.doi.org/10.1186/s12871-022-01748-9 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Li, Caifeng Ren, Qian Li, Xin Han, Hongqiu Peng, Min Xie, Keliang Wang, Zhiqiang Wang, Guolin Effect of sigh in lateral position on postoperative atelectasis in adults assessed by lung ultrasound: a randomized, controlled trial |
title | Effect of sigh in lateral position on postoperative atelectasis in adults assessed by lung ultrasound: a randomized, controlled trial |
title_full | Effect of sigh in lateral position on postoperative atelectasis in adults assessed by lung ultrasound: a randomized, controlled trial |
title_fullStr | Effect of sigh in lateral position on postoperative atelectasis in adults assessed by lung ultrasound: a randomized, controlled trial |
title_full_unstemmed | Effect of sigh in lateral position on postoperative atelectasis in adults assessed by lung ultrasound: a randomized, controlled trial |
title_short | Effect of sigh in lateral position on postoperative atelectasis in adults assessed by lung ultrasound: a randomized, controlled trial |
title_sort | effect of sigh in lateral position on postoperative atelectasis in adults assessed by lung ultrasound: a randomized, controlled trial |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9275275/ https://www.ncbi.nlm.nih.gov/pubmed/35820814 http://dx.doi.org/10.1186/s12871-022-01748-9 |
work_keys_str_mv | AT licaifeng effectofsighinlateralpositiononpostoperativeatelectasisinadultsassessedbylungultrasoundarandomizedcontrolledtrial AT renqian effectofsighinlateralpositiononpostoperativeatelectasisinadultsassessedbylungultrasoundarandomizedcontrolledtrial AT lixin effectofsighinlateralpositiononpostoperativeatelectasisinadultsassessedbylungultrasoundarandomizedcontrolledtrial AT hanhongqiu effectofsighinlateralpositiononpostoperativeatelectasisinadultsassessedbylungultrasoundarandomizedcontrolledtrial AT pengmin effectofsighinlateralpositiononpostoperativeatelectasisinadultsassessedbylungultrasoundarandomizedcontrolledtrial AT xiekeliang effectofsighinlateralpositiononpostoperativeatelectasisinadultsassessedbylungultrasoundarandomizedcontrolledtrial AT wangzhiqiang effectofsighinlateralpositiononpostoperativeatelectasisinadultsassessedbylungultrasoundarandomizedcontrolledtrial AT wangguolin effectofsighinlateralpositiononpostoperativeatelectasisinadultsassessedbylungultrasoundarandomizedcontrolledtrial |