BACKGROUND Despite previous reports suggesting that pressure support ventilation facilitates weaning from mechanical ventilation in the intensive care unit, few studies have assessed its effects on recovery from anesthesia. The authors hypothesized that pressure support ventilation during emergence from anesthesia reduces postoperative atelectasis in patients undergoing laparoscopic surgery using the Trendelenburg position. METHODS In this randomized controlled double-blinded trial, adult patients undergoing laparoscopic colectomy or robot-assisted prostatectomy were assigned to either the pressure support (n = 50) or the control group (n = 50). During emergence (from the end of surgery to extubation), pressure support ventilation was used in the pressure support group versus intermittent manual assistance in the control group. The primary outcome was the incidence of atelectasis diagnosed by lung ultrasonography at the postanesthesia care unit (PACU). The secondary outcomes were Pao2 at PACU and oxygen saturation measured by pulse oximetry less than 92% during 48 h postoperatively. RESULTS Ninety-seven patients were included in the analysis. The duration of emergence was 9 min and 8 min in the pressure support and control groups, respectively. The incidence of atelectasis at PACU was lower in the pressure support group compared to that in the control group (pressure support vs. control, 16 of 48 [33%] vs. 28 of 49 [57%]; risk ratio, 0.58; 95% CI, 0.35 to 0.91; P = 0.024). In the PACU, Pao2 in the pressure support group was higher than that in the control group (92 ± 26 mmHg vs. 83 ± 13 mmHg; P = 0.034). The incidence of oxygen saturation measured by pulse oximetry less than 92% during 48 h postoperatively was not different between the groups (9 of 48 [19%] vs. 11 of 49 [22%]; P = 0.653). There were no adverse events related to the study protocol. CONCLUSIONS The incidence of postoperative atelectasis was lower in patients undergoing either laparoscopic colectomy or robot-assisted prostatectomy who received pressure support ventilation during emergence from general anesthesia compared to those receiving intermittent manual assistance. EDITOR’S PERSPECTIVE

中文翻译：

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麻醉出现期间压力支持与自主通气对术后肺不张的影响：一项随机对照试验。

背景 尽管先前的报道表明压力支持通气有助于重症监护病房机械通气的撤机，但很少有研究评估其对麻醉恢复的影响。作者假设麻醉苏醒期间的压力支持通气可减少使用特伦德伦伯卧位进行腹腔镜手术的患者术后肺不张。方法 在这项随机对照双盲试验中，接受腹腔镜结肠切除术或机器人辅助前列腺切除术的成年患者被分配到压力支持组（n = 50）或对照组（n = 50）。在苏醒期间（从手术结束到拔管），压力支持组采用压力支持通气，而对照组采用间歇手动辅助。主要结果是在麻醉后监护病房 (PACU) 通过肺部超声诊断的肺不张发生率。次要结果是术后 48 小时内 PACU 的 Pao2 和通过脉搏血氧仪测量的氧饱和度低于 92%。结果 97 名患者被纳入分析。压力支持组和对照组的出现持续时间分别为 9 分钟和 8 分钟。压力支持组的肺不张发生率低于对照组（压力支持组与对照组相比，48 例中的 16 例 [33%] 对 49 例中的 28 例 [57%]；风险比，0.58；95 % CI，0.35 至 0.91；P = 0.024)。在 PACU 中，压力支持组的 Pao2 高于对照组（92 ± 26 mmHg vs. 83 ± 13 mmHg；P = 0.034）。术后 48 小时通过脉搏血氧仪测量的氧饱和度低于 92% 的发生率在两组之间没有差异（48 人中有 9 人 [19%] 对 49 人中有 11 人 [22%]；P = 0.653）。没有与研究方案相关的不良事件。结论 与接受间歇性人工辅助的患者相比，接受腹腔镜结肠切除术或机器人辅助前列腺切除术的患者在全身麻醉苏醒期间接受压力支持通气的术后肺不张发生率较低。编辑观点 结论 与接受间歇性人工辅助的患者相比，接受腹腔镜结肠切除术或机器人辅助前列腺切除术的患者在全身麻醉苏醒期间接受压力支持通气的术后肺不张发生率较低。编辑观点 结论 与接受间歇性人工辅助的患者相比，接受腹腔镜结肠切除术或机器人辅助前列腺切除术的患者在全身麻醉苏醒期间接受压力支持通气的术后肺不张发生率较低。编辑观点