Lung Ultrasonography in the Monitoring of Intraoperative Recruitment Maneuvers

Jolanta Cylwik,Natalia Buda

doi:10.3390/diagnostics11020276

Jolanta Cylwik, Natalia Buda

Open Access

https://doi.org/10.3390/diagnostics11020276

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Journal: Diagnostics	Publication Date: Feb 10, 2021
Citations: 9	License type: CC BY 4.0

Affiliation: Gdańsk Medical University

Abstract

Introduction: Postoperative respiratory failure is a serious problem in patients who undergo general anesthesia. Approximately 90% of mechanically ventilated patients during the surgery may develop atelectasis that leads to perioperative complications. Aim: The aim of this study is to determine whether it is possible to optimize recruitment maneuvers with the use of chest ultrasonography, thus limiting the risk of respiratory complications in patients who undergo general anesthesia. Methodology: The method of incremental increases in positive end-expiratory pressure (PEEP) values with simultaneous continuous ultrasound assessments was employed in mechanically ventilated patients. Results: The study group comprised 100 patients. The employed method allowed for atelectasis reduction in 91.9% of patients. The PEEP necessary to reverse areas of atelectasis averaged 17cmH2O, with an average peak pressure of 29cmH2O. The average PEEP that prevented repeat atelectasis was 9cmH2O. A significant improvement in lung compliance and saturation was obtained. Conclusions: Ultrasound-guided recruitment maneuvers facilitate the patient-based adjustment of the process. Consequently, the reduction in ventilation pressures necessary to aerate intraoperative atelectasis is possible, with the simultaneous reduction in the risk of procedure-related complications.

Highlights

Postoperative respiratory failure is a serious problem in patients who undergo general anesthesia
The aim of the study is to determine whether the application of chest ultrasonography allows optimizing intraoperative recruitment maneuvers that reduce atelectasis in mechanically ventilated patients under general anesthesia
The main aim of this study was to determine whether the suggested recruitment method with a simultaneous ultrasound assessment may lead to the reduction in mechanical ventilation pressures owing to the patient-based adjustment of the therapy

Summary

Introduction

Postoperative respiratory failure is a serious problem in patients who undergo general anesthesia. Despite extensive advances in regional anesthesia methods, general anesthesia still remains indispensable for some surgical procedures—approximately 90% of surgical patients develop disturbances of lung aeration following positive pressure mechanical ventilation [1,2]. The extent and severity of perioperative disturbances of lung aeration may vary from small and clinically insignificant local hypoventilation areas to the appearance of large areas of completely nonaerated lung tissue This may contribute to the development of intra- and post-operative complications [4,6], including gas exchange pathologies (mainly hypoxia), and may potentially trigger a local inflammatory response leading to lung damage (VILI—ventilator-induced lung injury) [7,8,9]. Irrespective of how the recruitment is administered, this procedure involves the risk of complications (e.g., barotrauma, volutrauma, hemodynamic destabilization)

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