BACKGROUND Desaturation frequently occurs in infants after general anaesthesia in the prone position. We aimed to evaluate the effect of regular alveolar recruitment in preventing atelectasis in infants and children after general anaesthesia in the prone position. METHODS Children (<3 yr) undergoing general anaesthesia (>2 h) in the prone position were randomised to either receive regular alveolar recruitment or standardised care without recruitment. Ultrasound-guided alveolar recruitment was performed for both groups, and mechanical ventilation was started with a tidal volume of 6 ml kg-1 and PEEP of 7 cm H2O. During mechanical ventilation, the intervention (regular recruitment) group received alveolar recruitment once per hour. Lung ultrasound was performed after inducing anaesthesia and each position change. The primary outcome was the incidence of significant atelectasis (defined by consolidation score ≥2 in any region) before extubation, as evaluated by lung ultrasound undertaken by an investigator masked to trial allocation. RESULTS Seventy-three children (regular recruitment: 37; standardised care: 36) were included in the analysis. Before the hourly intervention, atelectasis was similar between children randomised to regular alveolar recruitment or standardised care in both supine (83.3%, both groups; P>0.99) and prone positions (88.9% vs 91.9%; P=0.970). The incidence of atelectasis before extubation was lower in children receiving regular alveolar recruitment (8.1%), compared with 47.2% in children randomised to standardised care (absolute risk reduction: 39.1% [95% confidence interval: 20.6-57.6%); P<0.001). CONCLUSIONS Regular alveolar recruitment reduced the incidence of atelectasis at the end of surgery in infants and children <3 yr undergoing general anaesthesia in the prone position. CLINICAL TRIAL REGISTRATION NCT03486847.

中文翻译：

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常规肺泡募集对小儿通气俯卧位患者术中肺不张的影响：一项随机对照试验。

背景技术在全身麻醉后的俯卧位中，婴儿经常发生脱饱和。我们的目的是评估俯卧位全身麻醉后常规肺泡募集对预防婴儿和儿童肺不张的效果。方法将俯卧位接受全麻（> 2 h）的儿童（<3岁）随机接受常规肺泡募集或不进行募集的标准化护理。两组均进行超声引导的肺泡募集，潮气量为6 ml kg-1，PEEP为7 cm H2O时开始机械通气。在机械通气期间，干预（常规补充）组每小时接受一次肺泡补充。诱导麻醉和每个位置改变后进行肺超声检查。主要结果是拔管前显着的肺不张发生率（在任何区域由固结分数≥2定义），这是由研究者进行的肺超声评估得出的，该研究掩盖了试验分配。结果分析共纳入73名儿童（常规招募：37名；标准护理：36名）。每小时干预前，仰卧位（两组分别为83.3％，两组； P> 0.99）和俯卧位（88.9％对91.9％； P = 0.970）中，随机接受常规肺泡募集或标准化护理的儿童之间的肺不张相似。接受常规肺泡募集的儿童拔管前肺不张的发生率较低（8.1％），而接受标准化护理的儿童则为47.2％（绝对危险度降低：39.1％[95％置信区间：20.6-57.6％]；P ＜0.001）。结论常规肺泡募集减少了在俯卧位接受全身麻醉的3岁以下的婴幼儿手术后肺不张的发生率。临床试验注册NCT03486847。