Atelectasis After Inhalation or Intravenous Induction in Pediatric Anesthesia

Atelectasis Clinical Trial

— AtelectLUS  

Official title:

Atelectasis Evaluated With Lung Ultrasound After Inhalation or Intravenous Induction in Pediatric Anesthesia: a Prospective, Observational, Propensity Scored Matched Study

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT06069414
• Other study ID #: 2022/ST/147
• Status: Completed
• Start date: April 1, 2023
• Est. completion date: November 1, 2023

Study information

• Verified date: April 2024
• Source: Vittore Buzzi Children's Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Children have a highly compliant chest wall and atelectasis formation occurs often during pediatric anesthesia. Inhalation induction is commonly performed in pediatric anesthesia but it is still unclear if this can have an effect on the development of atelectasis. Aim of this study is to investigate the impact of inhalation versus intravenous induction on atelectasis formation during anesthesia induction in children. Atelectasis will be evaluated with lung ultrasound before induction and right after induction.

Description:

Respiratory complications, among which atelectasis, are a common cause of adverse events in pediatric anesthesia. Lung ultrasound (LUS) examination is a point of care, non-invasive, radiation-free tool with high sensitivity and specificity for the identification of anesthesia-induced atelectasis in children.

Inhalation induction is commonly performed in pediatric anesthesia to avoid pain at venipuncture or to facilitate vein cannulation. This technique has been associated with a higher rate of respiratory adverse events but no study has investigated the role of inhalation or intravenous induction on lung atelectasis development in pediatric anesthesia.

The investigators will perform this study aiming to describe the impact of inhalation versus intravenous induction technique on atelectasis formation during anesthesia induction in children of different ages.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 326
• Est. completion date: November 1, 2023
• Est. primary completion date: October 1, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 0 Years to 18 Years

Eligibility

Inclusion Criteria:

• scheduled for elective surgery under general anesthesia

• parental consent

Exclusion Criteria:

• American Society of Anesthesiologists (ASA) physical status III-VI

• neuromuscular disease

• chronic lung disease

• cardiopathy

• thoracic cage malformations

• chronic home ventilation (either invasive or non-invasive)

• positive history of foreign body inhalation

• required immediate life-saving procedures

• lack of parental consent

Related Conditions & MeSH terms

• Atelectasis
• Pediatric Anesthesia
• Pulmonary Atelectasis

Intervention

Other:
• Type of anesthesia induction
Patients will receive inhalatory or intravenous anesthesia at their choice; both groups will be evaluated with lung ultrasound after induction to detect ultrasonografic signs of atelectasis

Locations

Country	Name	City	State
Italy	Vittore Buzzi Children's Hospital	Milan

Sponsors (1)

Lead Sponsor	Collaborator
Vittore Buzzi Children's Hospital

Country where clinical trial is conducted

Italy, 

References & Publications (5)

Acosta CM, Maidana GA, Jacovitti D, Belaunzaran A, Cereceda S, Rae E, Molina A, Gonorazky S, Bohm SH, Tusman G. Accuracy of transthoracic lung ultrasound for diagnosing anesthesia-induced atelectasis in children. Anesthesiology. 2014 Jun;120(6):1370-9. doi: 10.1097/ALN.0000000000000231. — View Citation

Adler AC, Siddiqui A, Chandrakantan A, Matava CT. Lung and airway ultrasound in pediatric anesthesia. Paediatr Anaesth. 2022 Feb;32(2):202-208. doi: 10.1111/pan.14337. Epub 2021 Dec 1. — View Citation

de Graaff JC, Bijker JB, Kappen TH, van Wolfswinkel L, Zuithoff NP, Kalkman CJ. Incidence of intraoperative hypoxemia in children in relation to age. Anesth Analg. 2013 Jul;117(1):169-75. doi: 10.1213/ANE.0b013e31829332b5. Epub 2013 May 17. — View Citation

Sargent MA, McEachern AM, Jamieson DH, Kahwaji R. Atelectasis on pediatric chest CT: comparison of sedation techniques. Pediatr Radiol. 1999 Jul;29(7):509-13. doi: 10.1007/s002470050632. — View Citation

Zeng C, Lagier D, Lee JW, Vidal Melo MF. Perioperative Pulmonary Atelectasis: Part I. Biology and Mechanisms. Anesthesiology. 2022 Jan 1;136(1):181-205. doi: 10.1097/ALN.0000000000003943. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Global LUS score	Sum of the LUS scores given to all the lung areas. Score points vary from 0 to 3, where 0 means normality of the lung and 3 refers to complete loss of aeration-tissue-like pattern or consolidation.	Upon completion of induction and subsequent controls at end of surgery and 1 postoperative day
Primary	Signs of atelectasis	Number of lung areas presenting a sub pleural consolidation	Upon completion of induction and and subsequent controls at end of surgery and 1 postoperative day