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Background <p>Atelectasis is a primary cause of impaired oxygenation and reduced respiratory compliance during general anesthesia. Recruitment maneuvers (RMs) can effectively counteract atelectasis; however, the optimal protocol regarding pressure, timing, and assessment method remains undefined. Therefore, this study utilized lung ultrasound (LUS) to evaluate the effectiveness of different RM pressures combined with positive end-expiratory pressure (PEEP) in reducing atelectasis and improving oxygenation in surgical patients.</p> Methods <p>This prospective, randomized, assessor-blinded, 2 × 2 factorial trial enrolled adult patients undergoing elective thoracoscopic bilateral sympathectomy. Participants were randomized to one of four groups according to recruitment maneuver peak airway pressure (Ppeak 30 or 40 cmH₂O) and post-recruitment PEEP (0 or 8 cmH₂O): A (30/0), B (40/0), C (30/8), and D (40/8). A standardized recruitment maneuver (15&#xa0;s) at the assigned Ppeak was performed after completion of the right- and left-sided procedures. After the second maneuver, patients were ventilated in synchronized intermittent mandatory ventilation (SIMV) with the assigned PEEP until extubation. Primary outcomes were total LUS score and the incidence of postoperative atelectasis (defined as any region with LUS score ≥ 2), assessed in the PACU 30&#xa0;min after extubation.</p> Results <p>Among the 116 analyzed patients, the incidence of LUS-assessed postoperative atelectasis decreased across groups: 58.62% in Group A (17/29), 42.86% in Group B (12/28), 35.48% in Group C (11/31), and 21.43% in Group D (6/28). Compared with Group A, Group D had a significantly lower incidence (<i>P</i> = 0.009). Group A also had the highest LUS scores, which were significantly higher than those in each of the other three groups (all <i>P</i> &lt; 0.05).</p> Conclusions <p>A recruitment pressure of 40 cmH₂O, applied at the end of thoracoscopic bilateral sympathectomy, was superior to 30 cmH₂O in reducing both the LUS score and the rate of atelectasis. Moreover, applying 8 cmH₂O PEEP from recruitment until extubation significantly lowered LUS scores compared to no PEEP.</p> Trial registration <p>ISRCTN31424042; retrospectively registered on 6 February 2026.</p>

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Effect of different lung recruitment maneuvers on postoperative respiratory outcomes and lung aeration, assessed by lung ultrasound, in patients undergoing thoracoscopic sympathectomy: a randomized controlled trial

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  • 发表日期：

    2026年3月30日

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  • Dandan Chen,
  • Yuqian Chen,
  • Yanyu Wu,
  • Xianzhong Lin

摘要

Background

Atelectasis is a primary cause of impaired oxygenation and reduced respiratory compliance during general anesthesia. Recruitment maneuvers (RMs) can effectively counteract atelectasis; however, the optimal protocol regarding pressure, timing, and assessment method remains undefined. Therefore, this study utilized lung ultrasound (LUS) to evaluate the effectiveness of different RM pressures combined with positive end-expiratory pressure (PEEP) in reducing atelectasis and improving oxygenation in surgical patients.

Methods

This prospective, randomized, assessor-blinded, 2 × 2 factorial trial enrolled adult patients undergoing elective thoracoscopic bilateral sympathectomy. Participants were randomized to one of four groups according to recruitment maneuver peak airway pressure (Ppeak 30 or 40 cmH₂O) and post-recruitment PEEP (0 or 8 cmH₂O): A (30/0), B (40/0), C (30/8), and D (40/8). A standardized recruitment maneuver (15 s) at the assigned Ppeak was performed after completion of the right- and left-sided procedures. After the second maneuver, patients were ventilated in synchronized intermittent mandatory ventilation (SIMV) with the assigned PEEP until extubation. Primary outcomes were total LUS score and the incidence of postoperative atelectasis (defined as any region with LUS score ≥ 2), assessed in the PACU 30 min after extubation.

Results

Among the 116 analyzed patients, the incidence of LUS-assessed postoperative atelectasis decreased across groups: 58.62% in Group A (17/29), 42.86% in Group B (12/28), 35.48% in Group C (11/31), and 21.43% in Group D (6/28). Compared with Group A, Group D had a significantly lower incidence (P = 0.009). Group A also had the highest LUS scores, which were significantly higher than those in each of the other three groups (all P < 0.05).

Conclusions

A recruitment pressure of 40 cmH₂O, applied at the end of thoracoscopic bilateral sympathectomy, was superior to 30 cmH₂O in reducing both the LUS score and the rate of atelectasis. Moreover, applying 8 cmH₂O PEEP from recruitment until extubation significantly lowered LUS scores compared to no PEEP.

Trial registration

ISRCTN31424042; retrospectively registered on 6 February 2026.