• Change Zhu, Saiji Zhang, Junli Dong, and Rong Wei.
• From the Department of Anaesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China (CZ, SZ, JD, RW).
• Eur J Anaesthesiol. 2021 Oct 1; 38 (10): 102610331026-1033.

BackgroundAtelectasis is a common postoperative complication. Peri-operative lung protection can reduce atelectasis; however, it is not clear whether this persists into the postoperative period.ObjectiveTo evaluate to what extent lung-protective ventilation reduces peri-operative atelectasis in children undergoing nonabdominal surgery.DesignRandomised, controlled, double-blind study.SettingSingle tertiary hospital, 25 July 2019 to 18 January 2020.PatientsA total of 60 patients aged 1 to 6 years, American Society of Anesthesiologists physical status 1 or 2, planned for nonabdominal surgery under general anaesthesia (≤2 h) with mechanical ventilation.InterventionsThe patients were assigned randomly into either the lung-protective or zero end-expiratory pressure with no recruitment manoeuvres (control) group. Lung protection entailed 5 cmH2O positive end-expiratory pressure and recruitment manoeuvres every 30 min. Both groups received volume-controlled ventilation with a tidal volume of 6 ml kg-1 body weight. Lung ultrasound was conducted before anaesthesia induction, immediately after induction, surgery and tracheal extubation, and 15 min, 3 h, 12 h and 24 h after extubation.Main Outcome MeasuresThe difference in lung ultrasound score between groups at each interval. A higher score indicates worse lung aeration.ResultsPatients in the lung-protective group exhibited lower median [IQR] ultrasound scores compared with the control group immediately after surgery, 4 [4 to 5] vs. 8 [4 to 6], (95% confidence interval for the difference between group values -4 to -4, Z = -6.324) and after extubation 3 [3 to 4] vs. 4 [4 to 4], 95% CI -1 to 0, Z = -3.161. This did not persist from 15 min after extubation onwards. Lung aeration returned to normal in both groups 3 h after extubation.ConclusionsThe reduced atelectasis provided by lung-protective ventilation does not persist from 15 min after extubation onwards. Further studies are needed to determine if it yields better results in other types of surgery.Trial RegistrationChictr.org.cn (ChiCTR2000033469).Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care.

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