Ultrasound-guided versus conventional lung recruitment manoeuvres in laparoscopic gynaecological surgery: A randomised controlled trial

Abstract

Background: Pneumoperitoneum and steep Trendelenburg position promote the formation of pulmonary atelectasis during laparoscopic gynaecological surgery.

Objective: To determine whether lung ultrasound-guided alveolar recruitment manoeuvres could reduce peri-operative atelectasis compared with conventional recruitment manoeuvres during laparoscopic gynaecological surgery.

Design: Randomised controlled trial.

Setting: Tertiary hospital, Republic of Korea, from August 2018 to January 2019.

Patients: Adult patients scheduled for laparoscopic gynaecological surgery under general anaesthesia.

Intervention: Forty patients were randomised to receive either ultrasound-guided recruitment manoeuvres (manual inflation until no visibly collapsed area was seen with lung ultrasonography; intervention group) or conventional recruitment manoeuvres (single manual inflation with 30 cmH2O pressure; control group). Recruitment manoeuvres were performed 5 min after induction and at the end of surgery in both groups. All patients received volume-controlled ventilation with a tidal volume of 8 ml kg-1 and a positive end-expiratory pressure of 5 cmH2O.

Main outcome measures: The primary outcome was the lung ultrasound score at the end of surgery; a higher score indicates worse lung aeration.

Results: Lung ultrasound scores at the end of surgery were significantly lower in the intervention group compared with control group (median [IQR], 7.5 [6.5 to 8.5] versus 9.5 [8.5 to 13.5]; difference, -2 [95% CI, -4.5 to -1]; P = 0.008). The intergroup difference persisted in the postanaesthesia care unit (7 [5 to 8.8] versus 10 [7.3 to 12.8]; difference, -3 [95% CI, -5.5 to -1.5]; P = 0.005). The incidence of atelectasis was lower in the intervention group compared with control group at the end of surgery (35 versus 80%; P = 0.010) but was comparable in the postanaesthesia care unit (40 versus 55%; P = 0.527).

Conclusions: The use of ultrasound-guided recruitment manoeuvres improves peri-operative lung aeration; these effects may persist in the postanaesthesia care unit. However, the long-term effects of ultrasound-guided recruitment manoeuvres on clinical outcomes should be the subject of future trials.

Trial registration: ClinicalTrials.gov (NCT03607240).