Effect of an ultrasound-guided lung recruitment manoeuvre on postoperative atelectasis in children

BACKGROUND Ultrasound-guided alveolar recruitment, regardless of the technique, could be more effective because it facilitates real-time monitoring of the expansion of collapsed alveoli. OBJECTIVES To evaluate and compare the effects of an ultrasound-guided lung recruitment manoeuvre with those of a conventional recruitment manoeuvre on the occurrence of postoperative atelectasis and clinical outcomes in children. DESIGN A randomised controlled trial. SETTING Tertiary children's hospital. PATIENTS Children aged 6 years or less. INTERVENTION Children scheduled for simple, superficial procedures underwent lung ultrasound after tracheal intubation (T1), at the end of surgery (T2) and before discharge from the postanaesthesia care unit (T3). Following lung ultrasound evaluation at T1 and T2, the conventional recruitment manoeuvre with a maximal airway pressure of 30 cmH 2 O was performed in the control group, while an ultrasound-guided recruitment manoeuvre was performed in the ultrasound group. MAIN OUTCOME MEASURES The primary outcome was the incidence of significant atelectasis at T3. RESULTS The incidences of atelectasis at T3 were 20.9 and 11.6% in the control ( n = 43) and ultrasound groups ( n = 43), respectively (odds ratio [OR], 2.012; 95% confidence interval [CI], 0.614 to 6.594; P = 0.249). The lung ultrasound scores were better in the ultrasound group than in the control group at T2 and T3, and the incidence of postoperative desaturation was higher in the control group than in the ultrasound group (16.3 vs. 2.3%; OR, 0.12; 95% CI 0.01 to 1.04; P = 0.05). The median airway pressure required for full lung expansion in the ultrasound group was 35 cmH 2 O at T1 and T2. Other postoperative outcomes were similar between groups. CONCLUSION Ultrasound-guided lung recruitment may be more effective than the conventional procedure in terms of the prevention of intra-operative atelectasis and postoperative desaturation; however, its beneficial effects on postoperative atelectasis remain unclear. An inspiratory airway pressure of more than 30 cmH 2 O is required for full recruitment of alveoli in healthy children. CLINICAL TRIAL REGISTRY ClinicalTrials.gov (NCT03453762).