Hao Wei,Zhang Yan,Lu Yapeng,et al.Effect of driving pressure-guided individualized positive end-expiratory pressure titration on lung pro- tection and postoperative atelectasis during laparoscopy in children[J].Journal of Clinical Pediatric Surgery,,21():468-473.[doi:10.3760/cma.j.cn101785-202111021-013]
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Effect of driving pressure-guided individualized positive end-expiratory pressure titration on lung pro- tection and postoperative atelectasis during laparoscopy in children

Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R] volume: 第21卷 Number: 2022 05 Page: 468-473 Column: 论著 Date of publication: 2022-05-01
Author(s):
Hao Wei1; 2;  Zhang Yan1;  Lu Yapeng1; 2;  Liu Yang1; 2;  Zhong Hailian1; 2;  Zhang Rongzhi1;  Chen Yajing3;  Wang Yingbin1; 2
1 Department of Anesthesiology, Second Hospital, Lanzhou University, Lanzhou 730030, China;
2 Second Clinical School of Medicine, Lanzhou University, Lanzhou 730030, China;
3 Department of Pediatric Surgery, Second Hospi- tal, Lanzhou University, Lanzhou 730030, China
Keywords:
Laparoscopy; Anesthesia/MT; Positive-pressure Respiration; Pulmonary Ventilation; Lung Compliance; Pulmonary Atelectasis; Child
DOI:
10.3760/cma.j.cn101785-202111021-013
Abstract:
Objective To explore the influence of driving pressure-guided individualized positive end- expiratory pressure (PEEP) titration on lung protection and postoperative atelectasis in children undergoing lap- aroscopic surgery. Methods From June 2021 to October 2021, a total of 46 children undergoing laparoscopy at Second Hospital of Lanzhou University were selected as research subjects. They were divided randomly into two groups of fixed PEEP and driving pressure-guided individualized PEEP (n=23 each). Fixed PEEP group:5 cmH2 O (1 cmH2 O=0. 098 kPa) PEEP was set until end of operation. Driving pressure-guided individualized PEEP group:PEEP started from 2 cmH2 O with an increment of 1 cmH2 O and each PEEP level was maintained for 10 breathing cycles until the lowest driving pressure. There was a hourly repetition. Plateau pressure (Pplat), PEEP, driving pressure, lung dynamic compliance, mean arterial pressure (MAP) and heart rate (HR) were recorded at 5 min after tracheal intubation (T1),5 min after pneumoperitoneum (T2),4 min after PEEP (T3) and end of operation (T4);Lung Ultrasound Score (LUS) at T1,/T4/T5 (out of PACU) and intra- operative pneumoperitoneum time, pneumoperitoneum pressure, mechanical ventilation duration and operative duration were analyzed. Results As compared with T1, pulmonary dynamic compliance of two groups declined and driving pressure spiked obviously at T2. And the difference was statistically significant (P < 0. 05). As compared with T2, lung dynamic compliance and driving pressure of two groups improved markedly at T3 and T4 (P < 0. 05). As compared with fixed PEEP group, driving pressure-guided individualized PEEP group offered more advantages of improving lung dynamic compliance and reducing driving pressure and lung ultrasound score (P < 0. 05);no inter-group statistical difference existed in HR/MAP changes at different timepoints. Conclusion For ASA Ⅰ-Ⅱ children aged 1-6 years undergoing laparoscopy, driving pressure-guided individualized PEEP ventilation strategy can significantly improve lung dynamic compliance and reduce driving pressure and postoperative lung ultrasound scores.

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Memo

收稿日期:2021-11-10。
基金项目:兰州大学第二医院“萃英科技创新”计划（CY2019-BJ07、CY2020-BJ10）
通讯作者:王迎斌,Email:wangyingbin6@163.com

Last Update: 1900-01-01