The lung protective effects of two lung recruitment methods on children with congenital heart disease undergoing extracorporeal bypass surgery
WANG Yuan
HOU Yuwei
XU Lei
LIANG Na
WANG Yue
JIA Yingping
ZHANG Jiaqiang
Abstract：Objective To compare the lung protective effects of lung recruitment maneuver(RM)using the positive end-expiratory pressure(PEEP)increment method guided by lung ultrasound score(LUS)and the controlled inflation(SI)method in children with congenital heart disease(CHD)undergoing cardiopulmonary bypass(CPB)surgery.Methods A total of 84 children,aged 5 to 63 months,of American Society of Anesthesiologists(ASA)physical status Ⅰ or Ⅱ,scheduled for CPB-assisted CHD correction surgery at Henan Children's Hospital from December 2023 to February 2025 were randomly divided into the controlled inflation RM group(control group,n=42)and the PEEP increment RM group(experimental group,n=42).LUS,hemodynamic parameters,blood gas indicators,dynamic lung compliance,serum inflammatory factors[IL-6,TNF-α,procalcitonin(PCT)],postoperative pulmonary complications,extubation time,and hospital stay were compared before anesthesia induction(T0),before RM after tracheal intubation(T1),after RM after tracheal intubation(T2),before RM at the end of surgery(T3),after RM at the end of surgery(T4),at 24 h after surgery(T5),and 48 h after surgery(T6).And for each indicator at the T5 time point,stratified comparisons were conducted based on age(＜1-year-old infants and≥1-year-old toddlers).Results Compared with the control group,the experimental group had lower LUS scores and heart rate(HR)and higher mean arterial pressure(MAP)at T2,T4,T5,and T6(P＜0.05);significantly higher dynamic lung compliance at T2 and T4(P＜0.01);lower IL-6,TNF-α,and PCT levels at T3,T5,and T6(P＜0.05);higher arterial partial pressure of oxygen(PaO2)and oxygenation index(OI)at T2,T4,T5,and T6(P＜0.05 or P＜0.01);lower PPC incidence(P＜0.05);shorter extubation time(P＜0.05);and significantly shorter hospital stay(P＜0.01).Subgroup analysis showed that at T5,LUS,IL-6,PCT,and extubation time in the infant subgroup of the experimental group were lower than those in the child subgroup,while dynamic lung compliance was higher and OI was lower(P＜0.05).Conclusion LUS-guided PEEP increment RM has a significant lung protective effect in children with CHD undergoing CPB surgery,improving oxygenation,stabilizing hemodynamics,reducing inflammatory response,lowering postoperative pulmonary complications,and promoting postoperative recovery,with better effects in infants＜1 year old.
Keywords：congenital heart diseaselung ultrasound scorepositive end-expiratory pressure increment method lung recruitment maneuvercontrolled inflation method lung recruitment maneuvercardiopulmonary bypasslung protection
Publication Date：2025-10-15
Online Publishing Date：2025-09-30(First online date of this platform, not the publication date of the document)
Pages：8( 376-383 )