Zhang Yan,Liu Jieting,Hao Wei,et al.Application of lung ultrasound-guided individualized PEEP titration in pediatric laparoscopic surgery: a prospective randomized study[J].Journal of Clinical Pediatric Surgery,,():668-674.[doi:10.3760/cma.j.cn101785-202403029-013]
Application of lung ultrasound-guided individualized PEEP titration in pediatric laparoscopic surgery: a prospective randomized study
- Keywords:
- Lung Ultrasound; Positive-Pressure Respiration; Surgical Procedures; Operative; Laparoscopic; Child
- Abstract:
- Objective To evaluate the lung-protective efficacy of real-time lung ultrasound (LUS)-guided dynamic individualized positive end-expiratory pressure (PEEP) titration in pediatric laparoscopic surgery and to determine the optimal PEEP value. Methods A total of 44 pediatric patients undergoing elective laparoscopic surgery at the Second Hospital of Lanzhou University from December 2022 to May 2023 were prospectively enrolled and randomly assigned to either the conventional lung protective group (P group,fixed PEEP=5 cmH2O) or the LUS group (L group,dynamic PEEP titration).LUS scores,arterial partial pressure of oxygen (PaO2),and oxygenation index (OI) were recorded at three time points:after anesthesia induction (t1),at the end of surgery (t2),and 30 minutes post-extubation (t3).Plateau pressure (Pplat),dynamic lung compliance (Cydn),driving pressure (DP),and PEEP values were measured at following time points:5 minutes post-intubation and PEEP titration (T1),5 minutes (T2),1 hour (T3),2 hours (T4) post-pneumoperitoneum and PEEP titration,and at the end of surgery (T5). Results Comparisons of different lung protection methods showed statistically significant differences in LUS scores at t2[(5.4±1.7) vs.(4.3±1.1)],PaO2 values[(154.7±10.4) mmHg vs.(179.5±9.9) mmHg],and OI values[(336.6±12.7) mmHg vs.(354.4±16.4) mmHg],Pplat values at T2-T5[(18.6±2.5) cmH2O vs.(16.7±2.4) cmH2O,(19.2±2.1) cmH2O vs.(17.3±1.9) cmH2O,(20.6±3.2) cmH2O vs.(18.3±2.4) cmH2O,(15.3±2.7) cmH2O vs.(14.6±2.4) cmH2O],DP values at T1-T5[(8.6±2.9) cmH2O vs.(7.1±1.5) cmH2O,(13.5±2.6) cmH2O vs.(9.7±2.4) cmH2O,(14.2±2.1) cmH2O vs.(10.3±1.9) cmH2O,(15.6±3.2) cmH2O vs.(11.3±2.4) cmH2O,(10.3±2.7) cmH2O vs.(7.6±2.4) cmH2O],and Cdyn values at T2-T5[(15.4±2.8) cmH2O vs.(18.6±3.6) cmH2O,(13.1±3.3) cmH2O vs.(17.3±2.8) cmH2O,(12.5±2.5) cmH2O vs.(16.2±3.0) cmH2O,(16.7±2.8) cmH2O vs.(18.8±3.2) cmH2O](all P<0.05).No significant differences were observed in LUS scores at t1[(14.9±2.6) vs.(13.6±2.5)],PaO2 values at t3[(155.1±11.5) mmHg vs.(161.4±17.9) mmHg],Pplat values at T1[(13.6±2.9) cmH2O vs.(13.1±1.5) cmH2O],or Cdyn values at T1[(22.7±2.3) cmH2O vs.(23.3±2.9) cmH2O](P>0.05).Compared to the fixed PEEP of 5 cmH2O in the P group,the median PEEP in the L group was 6 cmH2O at T1 and 7 cmH2O at T2-T5. Conclusions Dynamic individualized PEEP titration guided by LUS monitoring can effectively reduce the occurrence of atelectasis,optimize lung oxygenation function,and improve respiratory mechanics parameters.A target PEEP value of 7 cmH2O is recommended for pediatric laparoscopic surgery.
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Memo
收稿日期:2024-3-24。
基金项目:甘肃省自然科学基金项目(23JRRA1633);兰州市城关区2024年科技计划及人才创新创业项目(2024JSCX0023)
通讯作者:刘婕婷,Email:49005100@qq.com