利用电阻抗断层扫描评估全身麻醉期间新生儿和小婴儿的肺均匀性：一项前瞻性观察研究

BJA open Pub Date : 2024-09-21 DOI:10.1016/j.bjao.2024.100344

Vanessa Marchesini , Sebastian Corlette , Suzette Sheppard , Andrew Davidson , David Tingay

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引用次数: 0

摘要

背景长时间的机械通气会造成不同的通气模式，从而增加婴儿肺损伤的风险。然而，人们对麻醉期间短暂暴露于机械通气的风险知之甚少。这项前瞻性观察研究的目的是利用电阻抗断层扫描描述健康新生儿和婴儿在全身麻醉期间肺通气的区域模式。麻醉和通气管理由主治临床医生决定。在麻醉过程中，从诱导到拔管后的六个时间点使用电阻抗断层扫描进行标准化肺部成像。结果诱导时潮气通气倾向于背侧肺区，通气中心（CoV）的中位数（四分位数间距）为 58.2 (53.9-59.3)%。插管后，通气重新分配到腹侧肺，最大的变化发生在手术早期：CoV为53.8（52.3-55.2）%。拔管后，CoV 恢复到插管前的值：56.5 (54.7-58)%.在所有时间点上，通气模式都偏向于右肺。这可能会造成临床上无法识别的肺损伤风险。这些结果表明，有必要更好地了解全身麻醉对发育中肺部的影响。临床试验注册澳大利亚新西兰临床试验注册中心（ACTRN 12616000818437，2016 年 6 月 22 日）。

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Evaluation of lung homogeneity in neonates and small infants during general anaesthesia using electrical impedance tomography: a prospective observational study

Background

Prolonged mechanical ventilation can create heterogeneous ventilation patterns, which increase the risk of lung injury in infants. However, little is understood about the risk of brief exposure to mechanical ventilation during anaesthesia. The aim of this prospective observational study was to describe the regional pattern of lung ventilation during general anaesthesia in healthy neonates and infants, using electrical impedance tomography.

Methods

Twenty infants (age 3 days to 12 months), without known lung disease and receiving general anaesthesia with endotracheal intubation for supine positioned surgery, were included in the study. Anaesthesia and ventilation management was at the discretion of the treating clinician. Standardised lung imaging using electrical impedance tomography was made at six time points during anaesthesia from induction to post-extubation. At each time point, the gravity-dependent and right–left lung centre of ventilation was calculated.

Results

Tidal ventilation favoured the dorsal lung regions at induction, with a median (inter-quartile range) centre of ventilation (CoV) of 58.2 (53.9–59.3)%. After intubation, there was a redistribution of ventilation to the ventral lung, with the greatest change occurring early in surgery: CoV of 53.8 (52.3–55.2)%. After extubation, CoV returned to pre-intubation values: 56.5 (54.7–58)%. Across all time points, the pattern of ventilation favoured the right lung.

Conclusions

General anaesthesia creates heterogenous patterns of ventilation similar to those reported during prolonged mechanical ventilation. This potentially poses a risk for lung injury that may not be recognised clinically. These results suggest the need to better understand the impact of general anaesthesia on the developing lung.