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Lung ultrasound-guided best positive end-expiratory pressure in neonatal anesthesia: a proposed randomized, controlled study

Pediatric Research volume 95, pages 393–396 (2024)Cite this article

Abstract

Background

Atelectasis is a common complication in neonatal anesthesia. Lung ultrasound (LUS) can be used intraoperatively to evaluate and recognize atelectatic lung areas. Hypotheses for the study are: (1) The use of LUS to guide choice of best positive end-expiratory pressure (PEEP) can lead to reduction of FiO2 to achieve same saturations of oxygen (SpO2). (2) In a less de-recruited lung, there will be less postoperative pulmonary complications. (3) Static respiratory system compliance could be different. (4) Hemodynamic parameters and amount of fluids infused or need for vasopressors intraoperatively could be different.

Methods

We propose a randomized controlled trial that compares standard PEEP settings with LUS-guided PEEP choice in patients under 2 months of age undergoing general anesthesia.

Results

The primary aim is to determine whether LUS-guided PEEP choice in neonatal anesthesia, compared to standard PEEP choice, can lead to reduction of FiO2 applied to the ventilatory setting in order to maintain same SpO2s. Secondary aims are to determine whether patients treated with LUS-guided PEEP will develop less postoperative pulmonary complications, will have a significant difference in hemodynamic parameters and amount of fluids or vasopressors infused, and in static respiratory system compliance.

Conclusions

We expect a significant reduction of FiO2 in LUS-guided ventilation.

Impact

  • Lung atelectasis is extremely common in neonatal anesthesia, because of the physiology of the neonatal lung and chest wall and leads to hypoxemia, being a lung area with a perfusion/ventilation mismatch.

  • Raising inspired fraction of oxygen can overcome temporarily hypoxemia but oxygen is a toxic compound for newborns. Lung ultrasound (LUS) can detect atelectasis at bedside and be used to optimize ventilator settings including choice of positive end-expiratory pressure (PEEP).

  • This randomized controlled trial (RCT) aims at demonstrating that LUS-guided choice of best PEEP during neonatal anesthesia can lead to reduction of inspired fractions of oxygen to keep same peripheral saturations SpO2.

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Data availability

After study completion, data will be available upon reasonable request.

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Funding

This study is unfunded.

Author information

Authors and Affiliations

  1. Department of Pediatric Anesthesia and Intensive Care, Buzzi Children’s Hospital, Milan, Italy

    Anna Camporesi & Giuseppe Paladini

  2. Pediatric Surgery Department, Buzzi Children’s Hospital, Milan, Italy

    Ugo Maria Pierucci & Gloria Pelizzo

  3. Department of Medical-Surgical Physiopathology and Transplants, University of Milan, Milan, Italy

    Andrea Gentile

  4. Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli”, Roma, Italy

    Danilo Buonsenso

  5. Department of Biomedical and Clinical Science, Luigi Sacco University Hospital, Milan, Italy

    Gloria Pelizzo

Authors
  1. Anna Camporesi
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  2. Ugo Maria Pierucci
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  3. Giuseppe Paladini
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  4. Andrea Gentile
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  5. Danilo Buonsenso
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  6. Gloria Pelizzo
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Contributions

A.C. and U.M.P. designed the study; A.C. and A.G. designed the statistical plan and the power analysis for the study; D.B. coordinated and supervised all aspects of the study, helped to draft the initial manuscript, and reviewed and revised the manuscript. A.C., U.M.P. G. Paladini, D.B., and G. Pelizzo reviewed and revised the protocol and critically reviewed the manuscript for important intellectual content. All authors reviewed the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Anna Camporesi.

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Camporesi, A., Pierucci, U.M., Paladini, G. et al. Lung ultrasound-guided best positive end-expiratory pressure in neonatal anesthesia: a proposed randomized, controlled study. Pediatr Res 95, 393–396 (2024). https://doi.org/10.1038/s41390-023-02730-y

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