Effectiveness of ultrasound-guided alveolar recruitment in thoracic surgery with one-lung ventilation: a randomized-controlled trial

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OBJECTIVES: Although alveolar recruitment strategy (ARS) before one-lung ventilation (OLV) is beneficial in intraoperative oxygenation, the optimal protocol remains unestablished. As lung ultrasound (LUS) has been used recently, we designed a randomized controlled trial to compare preemptive LUS-guided ARS with conventional ARS in thoracic surgery. METHODS: Patients aged 20-80 years scheduled to undergo lung resection surgery with OLV were randomized into 2 groups: (i) control group receiving conventional ARS and (ii) LUS group receiving LUS-guided ARS. ARS and modified LUS scoring were performed 5 min after intubation and before emergence. Arterial blood samples and respiratory parameters were collected every 30 min during OLV. The primary outcome was the incidence of intraoperative hypoxaemia (SpO2 < 95%). RESULTS: In total, 166 patients were included. The incidence of intraoperative hypoxaemia was 1.2% in the LUS group and 14.3% in the control group [risk ratio (95% CI) 0.09 (0.01-0.64), P = 0.002]. However, the incidence of intraoperative severe hypoxaemia (SpO2 < 90%) was not significantly different [1.2% vs 6.0%, risk ratio (95% CI) 0.20 (00.02-1.72), P = 0.213]. In the LUS before emergence, higher atelectasis score (P = 0.005) and more significant atelectasis (P = 0.031) was observed in the control group. Postoperative adverse outcomes were comparable between both groups. CONCLUSIONS: LUS-guided ARS before OLV was more effective than conventional ARS in preventing intraoperative hypoxaemia during thoracic surgery. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT03770793, 10 December 2018).

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