Among infants & children < 3y having prone general anaesthesia, regular hourly alveolar recruitment reduces pre-extubation atelectasis.

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• Young-Eun Jang, Sang-Hwan Ji, Eun-Hee Kim, Ji-Hyun Lee, Jin-Tae Kim, and Hee-Soo Kim.
• Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
• Br J Anaesth. 2020 May 1; 124 (5): 648-655.

BackgroundDesaturation frequently occurs in infants after general anaesthesia in the prone position. We aimed to evaluate the effect of regular alveolar recruitment in preventing atelectasis in infants and children after general anaesthesia in the prone position.MethodsChildren (<3 yr) undergoing general anaesthesia (>2 h) in the prone position were randomised to either receive regular alveolar recruitment or standardised care without recruitment. Ultrasound-guided alveolar recruitment was performed for both groups, and mechanical ventilation was started with a tidal volume of 6 ml kg-1 and PEEP of 7 cm H2O. During mechanical ventilation, the intervention (regular recruitment) group received alveolar recruitment once per hour. Lung ultrasound was performed after inducing anaesthesia and each position change. The primary outcome was the incidence of significant atelectasis (defined by consolidation score ≥2 in any region) before extubation, as evaluated by lung ultrasound undertaken by an investigator masked to trial allocation.ResultsSeventy-three children (regular recruitment: 37; standardised care: 36) were included in the analysis. Before the hourly intervention, atelectasis was similar between children randomised to regular alveolar recruitment or standardised care in both supine (83.3%, both groups; P>0.99) and prone positions (88.9% vs 91.9%; P=0.970). The incidence of atelectasis before extubation was lower in children receiving regular alveolar recruitment (8.1%), compared with 47.2% in children randomised to standardised care (absolute risk reduction: 39.1% [95% confidence interval: 20.6-57.6%); P<0.001).ConclusionsRegular alveolar recruitment reduced the incidence of atelectasis at the end of surgery in infants and children <3 yr undergoing general anaesthesia in the prone position.Clinical Trial RegistrationNCT03486847.Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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