Assessment of Lung Recruitment by Ultrasound in Patient Undergoing Upper Abdominal Surgery
R.K.Kamel, E.E.Afify, E.S.Abdelazeem and T.A.Abdelghany"
Atelectasis and poorly ventilated lung areas are negative consequences of general anesthesia observed in adult as well as in children. The reported incidence of this anesthesia-induced atelectasis is high and comes from 83 % to almost 100 %. The diagnosis of this entity is difficult to do at the bedside; they are commonly small and mostly invisible to standard chest X-ray images. Several methods have been suggested to reduce the impact of atelectasis during surgery. However, few intraoperative modalities for the diagnosis and monitoring of atelectasis are available. Lung ultrasound imaging is a promising non-invasive, non-radiant, portable and easy to use tool that as yet to be studied in the intraoperative setting. 80 adult patients with different ventilation strategies were divided into four groups, 20 patients were included in the 1st group conventional ventilation with large tidal volume 10ml/kg, with FiO2 1 with neither PEEP nor recruitment, 20 patients were included in the 2nd group conventional ventilation with large tidal volume 10ml/kg, with FiO2 0.6 with neither PEEP nor recruitment, 20 patients were included in the 3rd group protective lung ventilation with tidal volume 6ml/kg, with FiO2 1 plus recruitment and PEEP, and 20 patients were included in the 4th group protective lung ventilation with tidal volume 6ml/kg, with FiO2 0.6 plus recruitment and PEEP comparative study between lung ultrasound atelectasis score (LUS), the median and Interquartile range (IQR) of lung ultrasound score was done. There was statistically significant difference between the four groups of the study at all times except for baseline reading (P<0.001). There might have been noteworthy distinction in the same one assembly viewing the sum lung score readings following incitement from claiming anesthesia in examination with benchmark perusing clinched alongside non initiate Assemblies same time no Contrast to same one assembly correlations for benchmark perusing Previously, initiate one assembly separated starting with T4( T4 vs T0 p<0. 001). Those intend Â± standard deviation (SD) for fractional weight of oxygen will portion propelled oxygen (Po2/Fio2) proportion were finished. There might have been statistically huge Contrast between gatherings of the consider with higher P/F proportion On recruitment gathering in the least times but at benchmark (P<0. 001). Additionally there might have been no Contrast in the same bunch correlations in regards P/F proportion readings after incitement about anesthesia in examination with benchmark perusing over both aggregations separated from P/F proportion at T4 which need critical distinction starting with benchmark Previously, both groups( T4 vs T0 bunch a Also aggregation b p<0. 001, P=0. 006). There might have been a negative correspondence between lung ultrasonography score Also P/F proportion with measurable significances toward T1 (r=-0. 61, P<0. 001), In T2 (r=-0. 42, P=0. 006), during T3 (r=-0. 6, P<0. 001) Furthermore In T4(r=-0. 35, P=0. 023), there might have been no noteworthy Contrast over heart rate and in addition Circulatory strain between four Assemblies Furthermore and in addition no Contrast to inside aggregation correlations for benchmark. In decision CPAP recruitment manet trailed by peep essentially diminished those occurrence for anesthesia-induced atelectasis evaluated Toward a lung ultrasonography and moved forward P/F proportion On patients undergoing abdominal surgery for upper abdominal entry point.
Operative lung atelectasis, Lung ultrasound, Recruitment maneuver, Protective lung ventilation.