Impact of airway and a standardized recruitment maneuver on CT chest imaging quality in a pediatric population: A retrospective review

Introduction When performing computerized tomography chest imaging in children, obtaining high quality, motion‐free images is important in the accurate diagnosis of underlying pathology. General anesthesia is associated with the development of atelectasis, which can impair accurate diagnosis by obsc...

Full description

Saved in:
Bibliographic Details
Published in:Pediatric anesthesia 2022-04, Vol.32 (4), p.572-576
Main Authors: Bruins, Suze, Powers, Neil, Sommerfield, David, von Ungern‐Sternberg, Britta S
Format: Article
Language:English
Subjects:
Anesthesia, General
atelectasis
Child
General anesthesia
Humans
Infant
Lung
lung volume
Medical personnel
pediatric anesthesia
Pulmonary Atelectasis - diagnostic imaging
Pulmonary Atelectasis - therapy
recruitment maneuver
Retrospective Studies
Tomography
Tomography, X-Ray Computed - methods
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Introduction When performing computerized tomography chest imaging in children, obtaining high quality, motion‐free images is important in the accurate diagnosis of underlying pathology. General anesthesia is associated with the development of atelectasis, which can impair accurate diagnosis by obscuring or altering the appearance of the lung parenchyma or airways. Recruitment maneuvers, performed by anesthesiologists, can be used to effectively re‐expand atelectatic lung. Methods The computerized tomography chest imaging in 44 children aged between 2 months and 7 years, undergoing serial imaging for monitoring of cystic fibrosis, were reviewed and graded for atelectasis. The first scan performed on each child was performed with a supraglottic airway device and a non‐standardized recruitment maneuver. The second scan on each child was performed with a cuffed endotracheal tube and a standardized recruitment maneuver. Results When a supraglottic airway device and a non‐standardized recruitment maneuver were used, 77% of patients demonstrated atelectasis of any degree on their computerized tomography chest imaging, compared with only 39% when a cuffed endotracheal tube and standardized recruitment maneuver were used. The percentage of computerized tomography chest scans that were scored acceptable (with either a total combined lung atelectasis score of 0 or 1) improved from 37% to 75% when a cuffed endotracheal tube and standardized recruitment maneuver were used. In particular, the mean atelectasis score for both lungs improved from 2.91 (SD ± 2.6) to 1.11 (SD ± 1.9), with a mean difference of 1.8 (95% CI 0.82–2.77; p: .0004). Conclusion The use of a cuffed endotracheal tube and a standardized recruitment maneuver is an effective way to reduce atelectasis as a result of general anesthesia. Anesthesiologists can actively contribute toward improved image quality through their choice of airway and recruitment maneuver.
ISSN:1155-5645
1460-9592
DOI:10.1111/pan.14341