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The impact of ultrasound-guided recruitment maneuvers on the risk of postoperative pulmonary complications in patients undergoing general anesthesia

Jolanta Cylwik
Jolanta Cylwik
 y 
Natalia Buda
Natalia Buda
   | 08 feb 2022
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Article Category: Research paper
Publicado en línea: 08 feb 2022
Páginas: 6 - 11
Recibido: 19 sept 2021
Aceptado: 17 nov 2021
DOI: https://doi.org/10.15557/JoU.2022.0002
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© 2022 Jolanta Cylwik, Natalia Bud, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

Recruitment process with a good ultrasound effect: A. LUS image before anesthesia – normal, hyperechoic pleural line (↓) and A-line artifacts (→), normal image; B. control assessment during anesthesia, at PEEP 5 cm H2O – blurred, fragmented pleural line (↓), with small, hypoechoic subpleural consolidations (↑), image typical of atelectasis; C. when increasing PEEP to 11 cm H2O – persistent ultrasound features of atelectasis with a visible reduction of subpleural consolidations (↑); D. when achieving PEEP value of 13 cm H2O – normal, hyperechoic pleural line visible again (↓); E. when reducing pressures, PEEP 7 cm H2O – segmental disturbances in the pleural line continuity (↑) visible again – initial image of atelectasis; F. after increasing end-expiratory pressure by 2 cm H2O, disturbances in lung aeration reversed and normal pleural line and A-line artifacts were visualized
Recruitment process with a good ultrasound effect: A. LUS image before anesthesia – normal, hyperechoic pleural line (↓) and A-line artifacts (→), normal image; B. control assessment during anesthesia, at PEEP 5 cm H2O – blurred, fragmented pleural line (↓), with small, hypoechoic subpleural consolidations (↑), image typical of atelectasis; C. when increasing PEEP to 11 cm H2O – persistent ultrasound features of atelectasis with a visible reduction of subpleural consolidations (↑); D. when achieving PEEP value of 13 cm H2O – normal, hyperechoic pleural line visible again (↓); E. when reducing pressures, PEEP 7 cm H2O – segmental disturbances in the pleural line continuity (↑) visible again – initial image of atelectasis; F. after increasing end-expiratory pressure by 2 cm H2O, disturbances in lung aeration reversed and normal pleural line and A-line artifacts were visualized

Assessment of the postoperative period in both groups

VariableStudy group (n = 100)Control group (n = 100)Result
Hospitalization duration up to 10 days n (%)85 (85.0)67 (67.0)p = 0.003
Hospitalization duration more than 10 days n (%)(15.0)(33.0)
Respiratory tract infection n (%)0 (0)4 (4.0)p = 0.121
Prolonged mechanical ventilation n(%)2 (2.0)8 (8.0)p = 0.052
Number of hours of prolonged mechanical ventilationMe (IQR, min-max); M (SD)0 (0; 0–20); 0.25 (2.06)0 (0; 0–96); 2.96 (13.33)p = 0.049
Admission to ICU n (%)4 (4.0)13 (13.0)p = 0.022
Deaths n (%)3 (3.0)5 (5.0)p = 0.721

List of publications devoted to ultrasound-guided recruitment maneuvers during general anesthesia

Author (year of publication)Study populationNumber of participants (study group/control group)Employed transducersUltrasound- guided recruitmentDetected incidence of atelectasisIncidence of atelectasis after RM
Cylwik, Buda (2021)adults100/0convex, linearyes87%16%
Park et al. (2021)adults20/20convexyes100%ND
Elshalzy et al. (2020)adults20/20convexyesNDND
Song et al. (2018)pediatric61/61linearyes21%13%
Song et al. (2016)pediatric20/20linearyes50%30%

Clinical characteristics of the study group and control group

VariableStudy group (n = 100)Control group (n = 100)Result
Age M (SD)63.90 (11.34)64.17 (14.03)p = 0.881
BMI M (SD)28.31 (5.08)29.61 (5.75)p = 0.173
Gender n (%)
Females Males66 (66.0) 34 (34.0)50 (50.0) 50 (50.0)p = 0.022
ASA Score n (%)
11 (1.0)4 (4.0)
2 327 (27.0) 66 (66.0)20 (20.0) 63 (63.0)p = 0.152
46 (6.0)13 (13.0)
MRC Score n (%)
049 (49.0)48 (57.8)
140 (40.0)20 (24.1)p = 0.056
211 (11.0)15 (18.1)
Coexisting chronic disease n (%)
Hypertension55 (55.0)66 (66.0)p = 0.112
Ischemic heart disease13 (13.0)17 (17.0)p = 0.428
COPD1 (1.0)3 (3.0)p = 0.621
Asthma6 (6.0)2 (2.0)p = 0.279
Diabetes24 (24.0)18 (18.0)p = 0.298
Atherosclerosis12 (12.0)15 (15.0)p = 0.535
Number of comorbidities n (%)
026 (26.0)24 (24.0)
126 (26.0)35 (35.0)
224 (24.0)23 (23.0)p = 0.635
319 (19.0)13 (13.0)
45 (5.0)5 (5.0)
Type of surgery n (%)
Elective Emergency90 (90.0) 10 (10.0)87 (87.0) 13 (13.0)p = 0.506
Surgeryduration n (%)
<2 h45 (45.0)43 (43.0)
2–4 h44 (44.0)40 (40.0)p = 0.467
>4 h11 (11.0)17 (17.0)
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