J Korean Med Sci.  2021 Dec;36(50):e334. 10.3346/jkms.2021.36.e334.

Assessment of Perioperative Atelectasis Using Lung Ultrasonography in Patients Undergoing Pneumoperitoneum Surgery in the Trendelenburg Position: Aspects of Differences according to Ventilatory Mode

• Lee YY
• Han JI
• Kang BK
• Jeong K
• Lee JW
• Kim DY

• KMID: 2523558
• DOI: http://doi.org/10.3346/jkms.2021.36.e334

Abstract

Background
During robotic gynecologic pneumoperitoneum surgery in the Trendelenburg position, aeration loss leads to perioperative atelectasis. Recently developed ventilator mode pressure-controlled ventilation volume-guaranteed (PCV-VG) mode could provide adequate ventilation with lower inspiratory pressure compared to volume-controlled ventilation (VCV); we hypothesized that PCV-VG mode may be beneficial in reducing perioperative atelectasis via low tidal volume (V_T ) of 6 mL/kg ventilation during robotic gynecologic pneumoperitoneum surgery in the Trendelenburg position. We applied lung ultrasound score (LUS) for detecting perioperative atelectasis. We aimed to compare perioperative atelectasis between VCV and PCV-VG with a low V_T of 6 mL/kg during pneumoperitoneum surgery in the Trendelenburg position using LUS.
Methods
Patients scheduled for robotic gynecologic surgery were randomly allocated to the VCV (n = 41) or PCV-VG group (n = 41). LUS, ventilatory, and hemodynamic parameters were evaluated at T1 (before induction), T2 (10 minutes after induction in the supine position), T3 (10 minutes after desufflation of CO₂ in the supine position), and T4 (30 minutes after emergence from anesthesia in the recovery room).
Results
Eighty patients (40 with PCV-VG and 40 with VCV) were included. Demographic data showed no significant differences between the groups. The total LUS has changed from baseline to T4, 0.63 (95% confidence interval [CI], 0.32, 0.94) to 1.77 (95% CI, 1.42, 2.21) in the VCV group and 0.86 (95% CI, 0.56, 1.16) to 1.43 (95% CI, 1.08, 1.78) in the PCV-VG group (P = 0.170). In both groups, total LUS increased significantly compared to the baseline values.
Conclusion
Using a low V_T of 6 mL/kg during pneumoperitoneum surgery in the Trendelenburg position, our study showed no evidence that PCV-VG ventilation was superior to VCV in terms of perioperative atelectasis.

Keyword

Clinical Research Information Service Identifier; KCT0006404

Figure

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  Fig. 1 Scheme for lung ultrasound investigation. Schematic image of the lung acquired from the lateral side of the patients who are in the supine position. The lung is divided into six quadrants by longitudinal AAL and PAL and an axial line (nipple line). The number indicates each quadrant of both the lungs (left or right). Three sections were divided by AAL and PAL: anterior section contains quadrants 1 and 2; lateral section contains quadrants 3 and 4; and posterior section contains quadrants 5 and 6.AAL = anterior axillary lines, PAL = posterior axillary lines.

• 

  Fig. 2 Lung ultrasound findings with different scores. The modified lung ultrasound scoring system was applied in accordance with the method of Monastesse et al.17 (A) A score of 0, normal aeration (0–2 B-lines); (B) 1, small loss of aeration (≥ 3 B-lines or multiple small subpleural consolidations separated by a normal pleural line); (C) 2, moderate loss of aeration (multiple small subpleural consolidations separated by a thickened or irregular pleural line) by intercostal posterobasal view; no patient exhibited severe loss of aeration corresponding to an lung ultrasound score of 3 points. Arrow: B lines, arrowhead: thickened or irregular pleural line.

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  Fig. 3 Consolidation standards of the reporting trials statement.VCV = volume-controlled ventilation, PCV-VG = pressure-controlled ventilation volume-guaranteed.

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