• Emanuela Zannin, Julie Nguyen, Sara Vigevani, Neil Hauser, David Sommerfield, Raffaele Dellacà, R Nazim Khan, Aine Sommerfield, and Britta S von Ungern-Sternberg.
• From the Technologies for Respiration Laboratory, Electronics, Information and Bioengineering Department (DEIB), Politecnico di Milano, Milan (EZ, SV, RD), Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy (EZ), Department of Anaesthesia and Pain Medicine, Perth Children's Hospital (JN, NH, DS, AS, BSvU-S), Perioperative Team, Perioperative Care Program, Telethon Kids Institute (JN, NH, DS, RNK, AS, BSvU-S), Institute for Paediatric Perioperative Excellence (NH, DS, RNK, AS, BSvU-S), Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School (NH, DS, AS, BSvU-S) and Department of Mathematics and Statistics, The University of Western Australia, Perth, Western Australia, Australia (RNK).
• Eur J Anaesthesiol. 2024 Jul 1; 41 (7): 513521513-521.

BackgroundAtelectasis has been reported in 68 to 100% of children undergoing general anaesthesia, a phenomenon that persists into the recovery period. Children receiving recruitment manoeuvres have less atelectasis and fewer episodes of oxygen desaturation during emergence. The optimal type of recruitment manoeuvre is unclear and may be influenced by the airway device chosen.ObjectiveWe aimed to investigate the different effects on lung mechanics as assessed by the forced oscillation technique (FOT) utilising different recruitment strategies: repeated inflations vs. one sustained inflation and different airway devices, a supraglottic airway device vs. a cuffed tracheal tube.DesignPragmatic enrolment with randomisation to the recruitment strategy.SettingWe conducted this single-centre trial between February 2020 and March 2022.ParticipantsSeventy healthy patients (53 boys) aged between 2 and 16 years undergoing general anaesthesia were included.InterventionsForced oscillations (5 Hz) were superimposed on the ventilator waveform using a customised system connected to the anaesthesia machine. Pressure and flow were measured at the inlet of the airway device and used to compute respiratory system resistance and reactance. Measurements were taken before and after recruitment, and again at the end of surgery.Main Outcome MeasuresThe primary endpoint measured is the change in respiratory reactance.ResultsStatistical analysis (linear model with recruitment strategy and airway device as factors) did not show any significant difference in resistance and reactance between before and after recruitment. Baseline reactance was the strongest predictor for a change in reactance after recruitment: prerecruitment Xrs decreased by mean (standard error) of 0.25 (0.068) cmH 2 O s l -1 per  1 cmH 2 O -1  s l -1 increase in baseline Xrs ( P  < 0.001). After correcting for baseline reactance, the change in reactance after recruitment was significantly lower for sustained inflation compared with repeated inflation by mean (standard error) 0.25 (0.101) cmH 2 O ( P  = 0.0166).ConclusionAlthough there was no significant difference between airway devices, this study demonstrated more effective recruitment via repeated inflations than sustained inflation in anaesthetised children.Trial RegistrationAustralian New Zealand Clinical Trials Registry: ACTRN12619001434189.Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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