Effect of lung-protective ventilation strategy on postoperative pulmonary complications in pediatric patients undergoing scoliosis surgery: a retrospective propensity score-matched cohort study / 中华麻醉学杂志

ABSTRACT

The data of pediatric patients who underwent scoliosis surgery from July 2016 to July 2019 were collected retrospectively.The pediatric patients were divided into traditional ventilation group (T group) and lung-protective ventilation group (P group) based on the ventilator settings.Standardized tidal volume(V T)was obtained by V T/ideal body weight (IBW). Patients with standardized V T ≥ 8 ml/kg and without positive end-expiratory pressure (PEEP) were included in group T, and patients with V T <8 ml/kg and PEEP 4-8 cmH 2O were included in group P. The propensity score was used to match the baseline information and intraoperative variables in the two groups.A total of 415 pediatric patients accepted screening, and 171 cases were successfully matched, including 92 cases in group T and 79 cases in group P. Compared with group T, the incidence and grade of pulmonary complications were significantly decreased at day 30 after operation, postanesthesia care unit stay time was shortened, body temperature was decreased at 24 h after operation, V T, standardized V T and oxygenation index were decreased, P ETCO 2, PEEP, ventilation frequency and I∶ E were increased ( P<0.05), and no significant change was found in IBW, PaCO 2, incidence of postoperative surgical complications and anesthesia-related complications, plasma C-reactive protein concentration and white blood cell count at 24 h after operation, hospitalization time and hospitalization cost in group P ( P>0.05). In conclusion, the lung-protective ventilation strategy low V T combined with PEEP can decrease the risk of postoperation lung complications and is helpful in improving prognosis in the pediatric patients undergoing scoliosis surgery as compared with traditional mechanical ventilation strategy.