Ultrasound-Guided Lung Recruitment Manoeuvre Shows Promise in Reducing Postoperative Atelectasis in Children

A randomised controlled trial conducted at a tertiary children's hospital evaluated the effects of an ultrasound-guided lung recruitment manoeuvre versus a conventional recruitment manoeuvre on postoperative atelectasis and clinical outcomes in children aged 6 years or less. The study involved children scheduled for simple, superficial procedures, who underwent lung ultrasound at various stages: after tracheal intubation (T1), at the end of surgery (T2), and before discharge from the postanaesthesia care unit (T3).

In the control group, a conventional recruitment manoeuvre with a maximal airway pressure of 30 cmH2O was performed, while the ultrasound group underwent an ultrasound-guided recruitment manoeuvre. The primary outcome measured was the incidence of significant atelectasis at T3.

Results showed that the incidence of atelectasis at T3 was 20.9% in the control group and 11.6% in the ultrasound group. Although the difference was not statistically significant, the ultrasound group demonstrated better lung ultrasound scores at T2 and T3 and a lower incidence of postoperative desaturation (2.3% vs. 16.3% in the control group). The median airway pressure required for full lung expansion in the ultrasound group was 35 cmH2O at T1 and T2.

The study concludes that while ultrasound-guided lung recruitment may be more effective in preventing intra-operative atelectasis and postoperative desaturation, its benefits regarding postoperative atelectasis are still unclear. It also highlights that an inspiratory airway pressure exceeding 30 cmH2O is necessary for full alveolar recruitment in healthy children.