Background
Methods
Patient’s eligibility criteria
Anesthesia, ventilatory treatment and monitoring
Gas exchange evaluated by the Air-test
Lung ultrasound
Protocol
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Control group (C group, n = 20). Ventilation was turned to pressure control ventilation using a fixed driving pressure of 12 cmH2O. PEEP was increased from 5 to 10 cmH2O along 3 min maintaining the supine position during the whole protocol time.
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Postural-recruitment maneuver group (P-RM group, n = 20). Ventilation was turned to pressure control ventilation using a driving pressure of 12 cmH2O and PEEP of 10 cmH2O, but they were immediately and sequentially placed: (1) in the left lateral position (90 s), (2) in the right lateral position (other 90 s), (3) back to the supine position (Fig. 1).
Statistical analysis
Results
Parameter | C-group, n = 20 | PR-group, n = 20 | p value* |
---|---|---|---|
Age (months) | 38.8 ± 19.1 | 40.9 ± 16.9 | 0.708 |
Male | 15 (75) | 12 (60) | 0.499 |
Female | 5 (25) | 8 (40) | |
Weight (kg) | 15.0 ± 3.9 | 14.8 ± 3.1 | 0.891 |
ASA I | 20 (100) | 20 (100) | 1.00 |
Duration of anesthesia (min) | 59.2 ± 17.9 | 60.9 ± 18.0 | 0.767 |
Type of surgery n (%) | |||
Laparoscopic herniorrhaphy | 5 (25) | 8 (40) | |
Tonsillectomy | 7 (35) | 8 (40) | |
Urological surgery | 7 (35) | 3 (15) | |
Wrist osteosynthesis | 0 (0) | 1 (5) | |
Resection angioma | 1 (5) | 0 (0) |
Parameter | C group | P-RM group | p value-between groups at T2 | ||||
---|---|---|---|---|---|---|---|
T1 | p value Intra-group | T2 | T1 | p value Intra-group | T2 | ||
Heart rate (bpm) | 102 ± 15 | 0.033 | 99 ± 14 | 95 ± 14 | 0.928 | 97 ± 14 | 0.678 |
MAP (mmHg) | 58 ± 7 | 0.338 | 58 ± 6 | 58 ± 6 | 0.763 | 59 ± 6 | 0.597 |
SpO2 (%) | 98.5 ± 0.8 | 0.500 | 98.4 ± 1.1 | 98.8 ± 0.7 | 0.996 | 99.3 ± 0.5 | 0.002 |
PETCO2 (mmHg) | 45 ± 3 | 0.006 | 42 ± 4 | 47 ± 4 | < 0.0001 | 39 ± 3 | 0.005 |
Pip (cmH2O) | 15 ± 2 | 0.002 | 17 ± 1 | 14 ± 2 | 0.003 | 16 ± 2 | 0.855 |
PEEP (cmH2O) | 5 | – | 8 | 5 | – | 8 | – |
Cdyn (cmH2O) | 14 ± 6 | 0.579 | 14 ± 5 | 15 ± 6 | 0.001 | 18 ± 6 | 0.0002 |
Rrs (cmH2O/L−1) | 33 ± 8 | 0.941 | 36 ± 11 | 33 ± 10 | 0.833 | 35 ± 12 | 0.839 |
Response | Predictive factors | ||||
---|---|---|---|---|---|
Treatment | Age/weight | Gender | Surgery time | Air-test | |
Score of aeration | < 0.0001 | 0.477 | 0.316 | 0.286 | 0.264 |
Heart rate (bpm) | 0.298 | 0.005 | 0.882 | 0.441 | 0.102 |
MAP (mmHg) | 0.940 | 0.316 | 0.966 | 0.241 | 0.180 |
SpO2 (%) | < 0.0001 | 0.879 | 0.013 | 0.104 | 0.601 |
PETCO2 (mmHg) | 0.407 | 0.748 | 0.643 | 0.794 | 0.360 |
Cdyn (mL/cmH2O) | 0.064 | 0.104 | 0.791 | 0.797 | 0.428 |
Pip (cmH2O) | 0.584 | 0.454 | 0.565 | 0.524 | < 0.0001 |