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

IF 4.2 2区 医学 Q1 ANESTHESIOLOGY
European Journal of Anaesthesiology Pub Date : 2024-12-01 Epub Date: 2024-09-05 DOI:10.1097/EJA.0000000000002063
Change Zhu, Mazhong Zhang, Saiji Zhang, Rufang Zhang, Rong Wei
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引用次数: 0

Abstract

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.

儿童肺切除术中的肺保护性通气和术后肺部并发症:前瞻性单中心随机对照试验。
背景:由于功能残余容量较小,闭合容积较大,儿童更容易出现术后肺部并发症(PPCs);然而,对于需要单肺通气(OLV)的儿童,肺保护性通气(LPV)的研究相对不足:评估 LPV 和驱动压力引导通气对单肺通气患儿肺保护功能的影响:随机、对照、双盲研究:地点:单点三级医院,2022 年 5 月 6 日至 2023 年 8 月 31 日:干预:213 名儿童儿童被随机分配到 LPV 组(142 人)或通气组(71 人)。LPV组的患儿被随机分配到接受个体化呼气末正压(PEEP)以提供最低驱动压力的驱动压力组(n = 70)或接受固定PEEP为5 cmH2O的传统保护性通气组(n = 72):主要结果:主要结果是术后 7 天内 PPC 的发生率。次要结果为肺力学、氧合作用和机械力:LPV 组(24/173,16.8%)和对照组(15/70,21.4%)的 PPC 发生率没有差异(P = 0.41)。驱动压力组的驱动压力低于 5 cmH2O PEEP 组(15 vs. 17 cmH2O;P = 0.001)。与 5 cmH2O PEEP 组相比,驱动压力组的肺顺应性和氧饱和度更高,而机械动力的动态成分更低。驾驶压力组(11/70,15.7%)和 5 cmH2O PEEP 组(13/72,18.1%)的 PPC 发生率没有差异(P = 0.71):结论:与非保护性通气相比,LPV 并未降低 PPC 的发生率。虽然驱动压力组的肺顺应性和氧合率高于 5 cmH2O PEEP 组,但这些优势并未转化为 PPCs 的显著减少。不过,该研究受限于样本量较小,这可能会影响对结果的解释。未来有必要进行样本量更大的研究,以证实这些发现:试验注册:ChiCTR2200059270。
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来源期刊
CiteScore
6.90
自引率
11.10%
发文量
351
审稿时长
6-12 weeks
期刊介绍: The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).
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