Effect of positive end-expiratory pressure on the incidence of atelectasis in children with congenital heart disease undergoing lateral thoracotomy under cardiopulmonary bypass

doi:10.3969/j.issn.1674-8115.2021.06.013

Abstract

Abstract: Objective

·To evaluate the incidence of atelectasis in children undergoing lateral thoracotomy cardiac surgery with cardiopulmonary bypass (CPB) by lung ultrasound, and investigate the effect of positive end-expiratory pressure (PEEP) on the incidence of atelectasis in these children.

Methods

·Sixty children undergoing selective lateral thoracotomy cardiac surgery with CPB in Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine from October 2019 to August 2020 were included. They were randomly divided into PEEP group (P group, n=30) and control group (C group, n=30). The P group was treated with 5 cmH₂O PEEP immediately after tracheal intubation until the end of operation. The C group was treated with 5 cmH₂O PEEP immediately after tracheal intubation until the beginning of operation. Lung ultrasound exam was performed three times in each patient, 1 min after starting mechanical ventilation of the lungs (T1), 1 min before the beginning of surgery (T2) and the time immediately upon completion of the surgery (T3). The lung ultrasound scores of the two groups were recorded, and the incidences of atelectasis were compared.

Results

·There was no significant difference in the incidences of atelectasis at T1 and T2 between the two groups. The incidence of atelectasis in P group was significantly lower than that in the C group at T3 (P=0.000). The incidence of atelectasis in the C group at T3 was significantly lower than those at T1 and T2 (all P<0.05).

Conclusion

·PEEP can significantly reduce the incidence of atelectasis in children undergoing lateral thoracotomy cardiac surgery with CPB.

Key words: atelectasis, positive end-expiratory pressure (PEEP), lung ultrasound, congenital heart disease, lateral thoracotomy

CLC Number:

R725.4

Pan HE, Ying SUN, Yan-yan YANG, Jie BAI, Ji-jian ZHENG, Ma-zhong ZHANG. Effect of positive end-expiratory pressure on the incidence of atelectasis in children with congenital heart disease undergoing lateral thoracotomy under cardiopulmonary bypass[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(6): 781-785.

Figures/Tables 6

TrendMD

References 19

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Item	P group (n=29)	C group (n=28)	P value
Age/year	1.7±0.6	1.8±0.5	0.576
Gender (male/female)/n	12/17	15/13	0.357
Weight/kg	10.6±2.1	11.8±2.4	0.830
Height/cm	81.2±13.5	84.0±10.9	0.892
ASA score (Ⅱ/Ⅲ)/ n	12/17	13/15	0.701
Surgery type/n(%)			0.509
ASD	16 (55.2)	13 (46.4)
VSD	13 (44.8)	15 (53.6)
Mechanical ventilation time/min	153.3±31.8	150.0±23.3	0.653
CPB time/min	44.6±19.1	40.7±16.6	0.491
Operation time/min	121.8±17.9	116.8±9.1	0.476

Item	P group (n=29)	C group (n=28)	P value
Age/year	1.7±0.6	1.8±0.5	0.576
Gender (male/female)/n	12/17	15/13	0.357
Weight/kg	10.6±2.1	11.8±2.4	0.830
Height/cm	81.2±13.5	84.0±10.9	0.892
ASA score (Ⅱ/Ⅲ)/ n	12/17	13/15	0.701
Surgery type/n(%)			0.509
ASD	16 (55.2)	13 (46.4)
VSD	13 (44.8)	15 (53.6)
Mechanical ventilation time/min	153.3±31.8	150.0±23.3	0.653
CPB time/min	44.6±19.1	40.7±16.6	0.491
Operation time/min	121.8±17.9	116.8±9.1	0.476

Time point	P group (n=29)	C group (n=28)	P value
T1	8 (27.6)	9 (32.1)	0.707
T2	11 (37.9)^①	10 (35.7)^②	0.862
T3	13 (44.8)^③⑤	26 (92.9)^④⑥	0.000

Time point	P group (n=29)	C group (n=28)	P value
T1	8 (27.6)	9 (32.1)	0.707
T2	11 (37.9)^①	10 (35.7)^②	0.862
T3	13 (44.8)^③⑤	26 (92.9)^④⑥	0.000

Regions of the lung	P group (n=29)	C group (n=28)	P value
L1?L2	2 (6.9)	3 (10.7)	0.670
L3?L4	3 (10.3)	10 (35.7)^①	0.029
L5?L6	5 (17.2)	13 (46.4)^②	0.018
R1?R2	2 (6.9)	3 (10.7)	0.670
R3?R4	1 (3.4)	2 (7.1)	0.611
R5?R6	3 (10.3)	2 (7.1)	1.000