Post‐extubation continuous positive airway pressure improves oxygenation after pediatric laparoscopic surgery: A randomized controlled trial

摘要

Background Effects of intraoperative recruitment maneuvers (RMs) on oxygenation and pulmonary compliance are lost during recovery if high inspired oxygen and airway suctioning are used. We investigated the effect of post‐extubation noninvasive CPAP mask application on the alveolar arterial oxygen difference [(A–a) DO 2 ] after pediatric laparoscopic surgery. Methods Sixty patients (1‐6?years) were randomly allocated to three groups of 20 patients, to receive zero end‐expiratory pressure (ZEEP group), RM with decremental PEEP titration only (RM group), or followed with post‐extubation CPAP for 5?minutes (RM‐CPAP group). Primary outcome was [(A–a) DO 2 ] at 1?hour postoperatively. Secondary outcomes were respiratory mechanics, arterial blood gas analysis, hemodynamics, and adverse events. Results At 1?hour postoperatively, mean [(A–a) DO 2 ] (mm?Hg) was lower in the RM‐CPAP group (41.5?±?13.2, [95% CI 37.6‐45.8]) compared to (80.2?±?13.7 [72.6‐87.5], P ??0.0001] and (59.2?±?14.6, [54.8‐62.6], P ??0.001) in the ZEEP and RM groups. The mean PaO 2 (mm?Hg) at 1?hour postoperatively was higher in the RM‐CPAP group (156.2?±?18.3 [95% CI 147.6‐164.7]) compared with the ZEEP (95.9?±?15.9 [88.5‐103.3], P ??0.0001) and RM groups (129.1?±?15.9 [121.6‐136.5], P ??0.0001). At 12?hours postoperatively, mean [(A–a) DO 2 ] and PaO 2 were (9.6?±?2.1 [8.4‐10.8]) and (91.9?±?9.4 [87.5‐96.3]) in the RM‐CPAP group compared to (25.8?±?5.5 [23.6‐27.6]) and (69.9?±?5.5 [67.4‐72.5], P ??0.0001) in the ZEEP group and (34.3?±?13.2, [28.4‐40.2], P ??0.0001) and (74.03 ± 9.8 [69.5‐78.6], P ??0.0001) in the RM group. No significant differences of perioperative adverse effects were found between groups. Conclusions An RM done after pneumoperitoneum inflation followed by decremental PEEP titration improved oxygenation at 1?hour postoperatively. The addition of an early post‐extubation noninvasive CPAP mask ventilation improved oxygenation at 12?hours postoperatively.