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Lung ultrasound evaluation of incremental PEEP recruitment maneuver in children undergoing cardiac surgery
Author(s) -
Sun Liping,
Wu Lei,
Zhang Kan,
Tan Ruizhen,
Bai Jie,
Zhang Mazhong,
Zheng Jijian
Publication year - 2020
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.24720
Subject(s) - medicine , atelectasis , oxygenation , anesthesia , cardiac surgery , ultrasound , mechanical ventilation , surgery , lung , radiology
Aim To explore the effect of incremental positive end‐expiratory pressure recruitment maneuver (iPEEPRM) in children with congenital heart diseases (CHDs) using lung ultrasound. Methods Thirty‐six children aged 3 months to 5 years scheduled for cardiac surgery participated. iPEEPRM was performed with PEEP stepwise increase (0‐5‐10‐15 cmH 2 O) and decrease at the same rate before and after surgery. Atelectatic areas, ultrasound scores, arterial oxygen pressure (PaO 2 ), and respiratory system dynamic compliance per kilogram body weight (CDyn/kg) were analyzed before and after iPEEPRM. The primary outcome is the incidence of atelectasis. Secondary outcomes are oxygenation, ventilation, CDyn/kg, and atelectasis area. Results iPEEPRM was successfully applied in 92% (33/36) children before surgery and 71% (24/34) children after surgery. The incidence of atelectasis was significantly reduced by iPEEPRM from 76% to 15% before surgery and from 92% to 38% after surgery, respectively ( P < .001). Before surgery, iPEEPRM significantly reduced atelectatic areas and ultrasound scores: 32.5 (0‐128.1) mm 2 vs 0 (0‐0) mm 2 and 8 (3‐12) vs 2 (0‐4). PaO 2 and CDyn/kg were significantly increased after iPEEPRM: 243 (129‐275) mm Hg vs 278 (207‐323) mm Hg and 0.6 (0.4‐0.7) mL/cmH 2 O/kg vs 0.8 (0.6‐1.0) mL/cmH 2 O/kg. After surgery, iPEEPRM significantly reduced atelectatic areas and ultrasound scores: 45.7 (13.1‐115.8) mm 2 vs 0 (0‐34.7) mm 2 , and 9 (6‐12) vs 3 (0‐5). PaO 2 and CDyn/kg were also significantly increased after iPEEPRM. Conclusions iPEEPRM effectively reduced atelectasis, improved lung aeration, oxygenation, and CDyn/kg in children undergoing cardiac surgery.