Effect of sigh in lateral position on postoperative atelectasis in adults assessed by lung ultrasound: a randomized, controlled trial

Background Postoperative atelectasis occurs in 90% of patients receiving general anesthesia. Recruitment maneuvers (RMs) are not always effective and frequently associated with barotrauma and hemodynamic instability. It is reported that many natural physiological behaviors interrupted under general...

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Published in:BMC anesthesiology 2022-07, Vol.22 (1), p.1-215, Article 215
Main Authors: Li, Caifeng, Ren, Qian, Li, Xin, Han, Hongqiu, Peng, Min, Xie, Keliang, Wang, Zhiqiang, Wang, Guolin
Format: Article
Language:English
Subjects:
Adults
Aeration
Analysis
Anesthesia
Atelectasis
Blood pressure
General anesthesia
General anesthesial
Hospital costs
Lateral position
Long-term effects
Lung ultrasound
Mechanical ventilation
Ostomy
Oxygen
Patients
Physiological aspects
Physiology
Pneumothorax
Recruitment maneuver
Sigh
Surgery
Tomography
Ultrasonic imaging
Ultrasound
Ventilators
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Summary:Background Postoperative atelectasis occurs in 90% of patients receiving general anesthesia. Recruitment maneuvers (RMs) are not always effective and frequently associated with barotrauma and hemodynamic instability. It is reported that many natural physiological behaviors interrupted under general anesthesia could prevent atelectasis and restore lung aeration. This study aimed to find out whether a combined physiological recruitment maneuver (CPRM), sigh in lateral position, could reduce postoperative atelectasis using lung ultrasound (LUS). Methods We conducted a prospective, randomized, controlled trial in adults with open abdominal surgery under general anesthesia lasting for 2 h or longer. Subjects were randomly allocated to either control group (C-group) or CPRM-group and received volume-controlled ventilation with the same ventilator settings. Patients in CPRM group was ventilated in sequential lateral position, with the addition of periodic sighs to recruit the lung. LUS scores, dynamic compliance (Cdyn), the partial pressure of arterial oxygen (PaO.sub.2) and fraction of inspired oxygen (FiO.sub.2) ratio (PaO.sub.2/FiO.sub.2), and other explanatory variables were acquired from each patient before and after recruitment. Results Seventy patients were included in the analysis. Before recruitment, there was no significant difference in LUS scores, Cdyn and PaO.sub.2/FiO.sub.2 between CPRM-group and C-group. After recruitment, LUS scores in CPRM-group decreased significantly compared with C-group (6.00 [5.00, 7.00] vs. 8.00 [7.00, 9.00], p = 4.463e-11 < 0.05), while PaO.sub.2/FiO.sub.2 and Cdyn in CPRM-group increased significantly compared with C-group respectively (377.92 (93.73) vs. 309.19 (92.98), p = 0.008 < 0.05, and 52.00 [47.00, 60.00] vs. 47.70 [41.00, 59.50], p = 6.325e-07 < 0.05). No hemodynamic instability, detectable barotrauma or position-related complications were encountered. Conclusions Sigh in lateral position can effectively reduce postoperative atelectasis even without causing severe side effects. Further large-scale studies are necessary to evaluate it's long-term effects on pulmonary complications and hospital length of stay. Trial registration ChiCTR1900024379. Registered 8 July 2019, Keywords: Sigh, Lateral position, Recruitment maneuver, Atelectasis, General anesthesial, Lung ultrasound
ISSN:1471-2253
1471-2253
DOI:10.1186/s12871-022-01748-9