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Modified Lung Ultrasound Examinations in Assessment and Monitoring of Positive End-Expiratory Pressure-Induced Lung Reaeration in Young Children With Congenital Heart Disease Under General Anesthesia*

Wu, Lei MD1; Hou, Qiaoru MD2; Bai, Jie MD1; Zhang, Jianwei MD1; Sun, Liping MD1; Tan, Ruizhen MD3; Zhang, Mazhong MD, PhD4; Zheng, Jijian MD, PhD4

Pediatric Critical Care Medicine: May 2019 - Volume 20 - Issue 5 - p 442-449
doi: 10.1097/PCC.0000000000001865
Cardiac Intensive Care
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Objectives: Lung ultrasound can reliably diagnose pulmonary atelectasis. The object of this study is to determine the most efficient region to assess changes in atelectasis in children with congenital heart disease under general anesthesia.

Design: Randomized controlled trial.

Setting: Operating room at university-affiliated children’s hospital.

Patients: Children between 3 months and 3 years old, scheduled for elective congenital heart disease surgery under general anesthesia.

Interventions: Forty children with congenital heart disease were randomly allocated to either a 5 cm H2O positive end-expiratory pressure group or a standard therapy control group.

Measurements and Main Results: Preoperative lung ultrasound was performed twice in each patient—after 1 and 15 minutes of mechanical ventilation. Atelectatic areas and B-lines were compared between two examinations. Different ultrasound regions were evaluated using Bland-Altman plots. The occurrence rate of atelectasis was much higher in inferoposterior lung regions (Scans 4–6) than in anterior and lateral regions (Scans 1–3). The median (interquartile range) lung ultrasound scores were lower in the positive end-expiratory pressure group than in the control group after treatment: 8 (3.3–9.8) versus 13 (8.3–17.5; p < 0.001). The atelectatic area was significantly decreased after treatment in the positive end-expiratory pressure group: 128 mm2 (34.5.5–213.3 mm2) versus 49.5 mm2 (5.3–75.5 mm2; p < 0.001). Bland-Altman plots revealed concordance between measurements in Scans 1–6 and those in Scans 4–6. In the posterior axillary line regions, changes in atelectatic area were significantly larger in the positive end-expiratory pressure group than in the control group (p = 0.03, 0.007, and 0.018).

Conclusions: Lung ultrasound in inferoposterior lung regions may be more likely to reflect changes in atelectasis and save examination time; 5 cm H2O positive end-expiratory pressure may be useful in lung reaeration and can reduce, but not eliminate, atelectasis in children with congenital heart disease.

1Department of Anesthesiology, Shanghai Children’s Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

2Diagnostic imaging Center, Shanghai Children’s Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

3Department of Obstetrics, Zhucheng People’s Hospital, Shandong, China.

4Department of Anesthesiology & Pediatric Clinical Pharmacology Laboratory, Shanghai Children’s Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

*See also p. 493.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Dr. Zheng received funding from the Medical Guide Project of the Shanghai Science and Technology Commission (16411967500) and the Shanghai Municipal Commission of Health and Family Planning, the Key Developing Disciplines (2015ZB0106). The remaining authors have disclosed that they do not have any potential conflicts of interest.

This work was performed at Shanghai Children’s Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, China.

For information regarding this article, E-mail: zhengjijian626@sina.com; zmzscmc@shsmu.edu.cn

Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies