Song Benqin,Wang Xiaomei,Zhang Bin,et al.Lung protective effects of dynamic lung compliance-guided titration of individualized positive end-expiratory pressure during lobectomy/segmentectomy in infants with congenital pulmonary airway malformations[J].Journal of Clinical Pediatric Surgery,2026,(01):64-69.[doi:10.3760/cma.j.cn101785-202408036]
Lung protective effects of dynamic lung compliance-guided titration of individualized positive end-expiratory pressure during lobectomy/segmentectomy in infants with congenital pulmonary airway malformations
- Keywords:
- Hypnosis; Anesthetic; Thoracoscopy; Cystic Adenomatoid Malformation of Lung; Congenital; Airway Management; Infant; Small for Gestational Age
- Abstract:
- Objective To explore the impact of individualized positive end-expiratory pressure (PEEP) titration guided by dynamic lung compliance (Cdyn) during one-lung ventilation (OLV) during infantile thoracoscopic lobectomy (segmentectomy) on lung-protective effects by observing the incidence of postoperative pulmonary complications (PPCs). Methods This prospective study included 90 infants with congenital pulmonary airway malformations (CPAM) undergoing thoracoscopic lobectomy (including lobectomy,anatomical segmentectomy or wedge resection) at Department of Anesthesiology,Shandong University Children’s Hospital from October 2018 to December 2022.They were randomized into observation group implementing a lung-protective ventilation strategy with Cdyn-guided individualized PEEP titration during OLV and control group with a fixed PEEP of 5 cm H2O.Hemodynamic parameters of mean arterial pressure (MAP),heart rate (HR),peak airway pressure (Ppeak),plateau pressure (Pplat),dynamic lung compliance (Cdyn),oxygenation index (PaO2/FiO2),alveolar-arterial oxygen difference[P(A-a)O2]and intrapulmonary shunt rate (Qs/Qt) were recorded at 15 min after double-lung ventilation (T1),30 min after PEEP setting (T2),60 min after PEEP setting (T3) and 15 min after resuming double-lung ventilation in lateral position (T4).The incidence of in-hospital pulmonary complications from surgery to discharge was also documented. Results When comparing different PEEP setting strategies,the incidence of PPCs was 5.0%(2/40) in experimental group and 22.5%(9/40) in control group; Cdyn values at T2-T3 for two groups were[(3.80±0.39) vs.(4.70±0.62) mL/cmH2O,(3.72±0.45) vs.(4.60±0.64) mL/cmH2O]; PaO2/FiO2 values at T2-T4 for two groups were[(251.30±42.23) vs.(267.45±37.28) mmHg,(252.93±42.03) vs.(273.07±39.87) mmHg,(298.59±49.18) vs.(332.74±41.64) mmHg]; P(A-a)O2 values[(153.40±33.94) vs.(131.96±19.44) mmHg,(156.66±24.13) vs.(146.71±17.86) mmHg,(93.28±14.01) vs.(81.49±15.87) mmHg]and Qs/Qt values[(22.74±3.45)% vs.(20.40±3.31)%,(22.11±3.19)% vs.(19.54±3.70)%,(8.01±2.02)% vs.(6.76±1.40)%]all showed statistically significant differences.Cdyn values at T1 and T4 for two groups were[(7.77±0.79) vs.(8.03±0.74) mL/cmH2O,(7.70±0.83) vs.(7.93±0.67) mL/cmH2O]; PaO2/FiO2 value at T1[(377.26±46.31) vs.(373.31±45.72) mmHg],P(A-a)O2 value[(75.67±19.29) vs.(74.98±16.29) mmHg]and Qs/Qt value[(5.16±0.89)% vs.(4.97±0.87)%]showed no statistically significant differences. Conclusions In CPAM infants undergoing lobectomy (segmentectomy),Cdyn-guided individualized PEEP titration during OLV can improve lung oxygenation during OLV,optimize respiratory mechanic parameters and lower the incidence of PPCs.
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Memo
收稿日期:2024-8-23。
基金项目:济南市卫生和计划生育委员会科技计划项目(2024304018)
通讯作者:王公明,Email:tagmwang1971@163.com