Change Zhu, Mazhong Zhang, Saiji Zhang, Rufang Zhang, Rong Wei
{"title":"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。","authors":"Change Zhu, Mazhong Zhang, Saiji Zhang, Rufang Zhang, Rong Wei","doi":"10.1097/EJA.0000000000002063","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>To evaluate the effects of LPV and driving pressure-guided ventilation on PPCs in children with OLV.</p><p><strong>Design: </strong>Randomised, controlled, double-blind study.</p><p><strong>Setting: </strong>Single-site tertiary hospital, 6 May 2022 to 31 August 2023.</p><p><strong>Patients: </strong>213 children aged < 6 years, planned for lung resection secondary to congenital cystic adenomatoid malformation.</p><p><strong>Interventions: </strong>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.</p><p><strong>Main outcome measures: </strong>The primary outcome was the incidence of PPCs within 7 days after surgery. Secondary outcomes were pulmonary mechanics, oxygenation and mechanical power.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Trial registration: </strong>ChiCTR2200059270.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Lung-protective ventilation and postoperative pulmonary complications during pulmonary resection in children: A prospective, single-centre, randomised controlled trial.\",\"authors\":\"Change Zhu, Mazhong Zhang, Saiji Zhang, Rufang Zhang, Rong Wei\",\"doi\":\"10.1097/EJA.0000000000002063\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>To evaluate the effects of LPV and driving pressure-guided ventilation on PPCs in children with OLV.</p><p><strong>Design: </strong>Randomised, controlled, double-blind study.</p><p><strong>Setting: </strong>Single-site tertiary hospital, 6 May 2022 to 31 August 2023.</p><p><strong>Patients: </strong>213 children aged < 6 years, planned for lung resection secondary to congenital cystic adenomatoid malformation.</p><p><strong>Interventions: </strong>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.</p><p><strong>Main outcome measures: </strong>The primary outcome was the incidence of PPCs within 7 days after surgery. Secondary outcomes were pulmonary mechanics, oxygenation and mechanical power.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Trial registration: </strong>ChiCTR2200059270.</p>\",\"PeriodicalId\":11920,\"journal\":{\"name\":\"European Journal of Anaesthesiology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.2000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Anaesthesiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/EJA.0000000000002063\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/9/5 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Anaesthesiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/EJA.0000000000002063","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/5 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Lung-protective ventilation and postoperative pulmonary complications during pulmonary resection in children: A prospective, single-centre, randomised controlled trial.
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.
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.
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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