Lung ultrasound to monitor the development of pulmonary atelectasis in gynecologic oncologic surgery.
Journal
Minerva anestesiologica
ISSN: 1827-1596
Titre abrégé: Minerva Anestesiol
Pays: Italy
ID NLM: 0375272
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
pubmed:
12
11
2020
medline:
1
9
2021
entrez:
11
11
2020
Statut:
ppublish
Résumé
Atelectasis formation is considered the major cause of hypoxemia during general anesthesia (GA). Gynecologic oncologic surgery (GOS) often requires pneumoperitoneum and steep bed angulation that further reduce lung compliance by shifting bowels and diaphragm. The aim of our study was to assess the impact of intraoperative variables on lung aeration using lung ultrasound (LUS) score and their correlation with postoperative oxygenation in women undergoing GOS. In this prospective observational study 80 patients scheduled for GOS were enrolled. After three minutes pre-oxygenation, propofol-sufentanil-sevoflurane GA and standard mechanical ventilation (MV) were administered (tidal volume of 8 mL/kg of predicted body weight, FiO<inf>2</inf> 40%, I:E ratio of 1:2 and PEEP 5 cm H<inf>2</inf>O). A 0-36 LUS score was calculated considering 12 pulmonary areas, and arterial blood gas analysis were performed before GA (T1) and in recovery room (T2). LUS score increased significantly between T1 (1.79±2.39) and T2 (11.08±4.40, ΔLUS=9.29±4.10, P<0.05), mostly in basal and posterior areas. Changes in LUS score correlated significantly with time of MV (r=0.246, P<0.05), cumulative time in TR position (r=0.321, P<0.05) and worsening in oxygenation (ΔPaO<inf>2</inf>/FiO<inf>2</inf>, r=-0.260, P<0.05). ΔLUS score significantly correlated with colloid infusion. The linear regression analysis showed that TR time can predict ΔLUS score (F<inf>1,78</inf>=8.97, P=0.004). No correlation was found with pneumoperitoneum, apnea time at induction and TR angle. Aeration loss after GOS detected using LUS correlates with TR time, MV time, colloid infusion and worsening in oxygenation.
Sections du résumé
BACKGROUND
Atelectasis formation is considered the major cause of hypoxemia during general anesthesia (GA). Gynecologic oncologic surgery (GOS) often requires pneumoperitoneum and steep bed angulation that further reduce lung compliance by shifting bowels and diaphragm. The aim of our study was to assess the impact of intraoperative variables on lung aeration using lung ultrasound (LUS) score and their correlation with postoperative oxygenation in women undergoing GOS.
METHODS
In this prospective observational study 80 patients scheduled for GOS were enrolled. After three minutes pre-oxygenation, propofol-sufentanil-sevoflurane GA and standard mechanical ventilation (MV) were administered (tidal volume of 8 mL/kg of predicted body weight, FiO<inf>2</inf> 40%, I:E ratio of 1:2 and PEEP 5 cm H<inf>2</inf>O). A 0-36 LUS score was calculated considering 12 pulmonary areas, and arterial blood gas analysis were performed before GA (T1) and in recovery room (T2).
RESULTS
LUS score increased significantly between T1 (1.79±2.39) and T2 (11.08±4.40, ΔLUS=9.29±4.10, P<0.05), mostly in basal and posterior areas. Changes in LUS score correlated significantly with time of MV (r=0.246, P<0.05), cumulative time in TR position (r=0.321, P<0.05) and worsening in oxygenation (ΔPaO<inf>2</inf>/FiO<inf>2</inf>, r=-0.260, P<0.05). ΔLUS score significantly correlated with colloid infusion. The linear regression analysis showed that TR time can predict ΔLUS score (F<inf>1,78</inf>=8.97, P=0.004). No correlation was found with pneumoperitoneum, apnea time at induction and TR angle.
CONCLUSIONS
Aeration loss after GOS detected using LUS correlates with TR time, MV time, colloid infusion and worsening in oxygenation.
Identifiants
pubmed: 33174404
pii: S0375-9393.20.14687-X
doi: 10.23736/S0375-9393.20.14687-X
doi:
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM