Effect of Lung-Protective Ventilation on Changes in Regional Cerebral Oxygen Saturation During Thoracoscopic Surgery in Children: A Prospective, Single-Center, Randomized Controlled Trial
Abstract
Highlights What are the main findings? For children undergoing thoracoscopic surgery with one-lung ventilation, lung-protective ventilation (4–6 mL/kg tidal volume plus 5 cmH2O PEEP) was associated with a markedly lower rate of intraoperative cerebral desaturation (≥20% fall in regional cerebral oxygen saturation), relative to conventional ventilation (8–10 mL/kg tidal volume, no PEEP). Patients receiving lung-protective ventilation exhibited higher nadir regional cerebral oxygen saturation values. Desaturation events decreased by more than 60% (14.6% versus 37.5%). Post-operative pulmonary complication rates fell by over half (14.6% versus 33.3%), and no pneumothorax cases occurred in this group. Median postoperative length-of-stay was one-day shorter in the lung-protective ventilation arm (4.0 versus 5.0 days), reflecting faster clinical recovery. What is the implication of the main finding? Low-tidal-volume ventilation (4–6 mL/kg during one-lung ventilation) was clinically feasible and well-tolerated. It maintained adequate surgical exposure without safety concerns, lending support for considering this protective strategy for pediatric one-lung-ventilation procedures. This work demonstrates the potential value of near-infrared spectroscopy to detect cerebral deoxygenation missed by pulse oximetry. The findings indicate that combined use of this monitor with lung-protective ventilation warrants further evaluation for optimizing paediatric perioperative care. Abstract…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 52 participants or records.
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