The effect of ultrasound-guided lung recruitment maneuvers on the prevention of perioperative atelectasis: a prospective randomized study

Aim: The incidence of perioperative atelectasis in pediatric patients is higher than in adults. Lung ultrasonography is an effective and reliable method for diagnosing atelectasis. This study aims to compare the effectiveness of recruitment and positional recruitment maneuvers in preventing anesthesia-related atelectasis in pediatric patients using lung ultrasonography. Material and Method: In this prospectively randomized study, 78 patients aged 1-14 years, classified as ASA I-III, were divided into three groups. Control Group: 5 cmH2O PEEP; Recruitment Group: 5 cmH2O PEEP + Recruitment Maneuver; Positional Recruitment Group: 5 cmH2O PEEP + Positional Recruitment Maneuver. Lung ultrasonography was performed four times for all groups at T1 (before induction), T2 (5 minutes after induction), T3 (end of surgery/before recruitment maneuver), and T4 (5 minutes after extubation). LUS and PLAPS scores, airway pressures, compliance values, and hemodynamic parameters were compared." Results: T4 LUS and PLAPS B-line scores were found to be significantly lower in the RM and PRM groups compared to the control group. While LUS and PLAPS B-line scores increased from T1 to T4 in the control and RM groups, they did not increase in the PRM group. A decrease was observed only in the PRM group between T3 and T4. Atelectasis was detected at a very low rate in all groups. No significant differences were found between the groups regarding airway pressures, compliance, and hemodynamic parameters. When comparing LUS and PLAPS scores, airway pressures, and compliance values, no age-related differences were detected." Conclusion: It has been determined through ultrasound that perioperative atelectasis in pediatric patients begins to develop early and increases during surgery. Positional Recruitment Maneuver (PRM) provided more effective lung ventilation compared to traditional Recruitment Maneuver (RM). It was observed that PRM did not cause hemodynamic instability in pediatric patients and that lung ultrasonography is a rapid, non-invasive option that provides real-time information.