Effect of ultrasound-guided lung recruitment to reduce pulmonary atelectasis after non-cardiac surgery under general anesthesia: a systematic review and meta-analysis of randomized controlled trials

Abstract

Abstract Background At present, the application of bedside lung ultrasound is increasing gradually, but there is no relevant expert consensus or guidance for its evaluation in the field of perioperative anesthesia. Through this meta-analysis, we tried to determine the impact of ultrasound-guided lung recruitment maneuvers (LRM) on perioperative patients. Methods We searched PubMed, Cochrane Library database, Embase and Clinical trials gov for the randomized controlled trials (RCTs) published up to December 31, 2022. The primary outcome was the incidence of postoperative atelectasis. Secondary outcomes included lung ultrasound score (LUS), the incidence of postoperative pulmonary complications (PPCs), the incidence of hypoxemia during resuscitation, driving pressure, lung compliance, mean arterial pressure (MAP), and heart rate (HR). A total of 443 patients were examined in nine randomized controlled trials. Results The incidence of atelectasis after surgery in patients with ultrasound-guided LRM was less (RR: 0.31; 95% CI: 0.25–0.40; p < 0.05), the LUS (WMD: -6.24; 95% CI: -6.90-5.59; p < 0.05) and the LUS of each part (LUS difference in front lung region (WMD: -2.00; 95% CI: -2.49 to -1.51; p < 0.05); LUS difference in lateral lung region (WMD: -2.50; 95% CI: -3.20 to -1.80; p < 0.05); The LUS of the posterior lung region was different (WMD: -3.24; 95% CI: -4.23 to -2.24; p < 0.05), and the incidence of hypoxemia during resuscitation was lower (RR: 0.33; 95% CI: 0.15 to 0.72; p < 0.05), and the lung compliance was higher (WMD: 5.30; 95% CI: 3.25 to 7.35; p < 0.05). There was no significant difference in PPCs (RR: 0.84; 95% CI: 0.41 to 1.70; p = 0.63), driving pressure (WMD: -0.24; 95% CI: -1.63 to 1.15; p > 0.05), MAP (WMD: -1.69; 95% CI: -1.69 to 2.40; p > 0.05) and HR (WMD: -2.52; 95% CI: -8.66 to 3.63; p > 0.05). Conclusion Ultrasound-guided lung recruitment manoeuvres can enhance perioperative lung aeration and lung compliance while reducing the development of atelectasis.Furthermore, these effects of ultrasound-guided lung recruitment manoeuvres are superior to non-ultrasound-guided ventilation strategy.