Optimizing perioperative lung protection strategies for reducing postoperative respiratory complications in pediatric patients: a narrative review
Qian Wang, Yanhong Li, Kuangyu Zhao, Jiaqiang Zhang, Jun Zhou
Abstract
Background and Objective: Despite significant advancements in the safe delivery of anesthesia and improvements in surgical techniques, postoperative respiratory complications (PRCs) remain a serious concern. PRCs can lead to increased length of hospital stay, worsened patient outcomes, and higher hospital and postoperative costs. Perioperative lung injury and PRCs are more common in children than in adults owing to children's unique physiology and anatomical characteristics. Studies have shown that lung-protective ventilation (LPV) strategies can improve lung function and minimize the risk of PRCs in adults. However, individualized LPV in children remains underexplored. This narrative review provides an overview of the various perioperative pulmonary protection strategies and their effect on pediatric PRCs. Methods: We searched PubMed for articles published from 2000 to 2024, setting our inclusion criteria to include studies that involved pediatric patients, addressed LPV strategies, and reported data on PRCs. Non-English language studies, case reports, editorials, conference abstracts, and non-full text published literatures were excluded. We utilized the following keyword strategy: (((lung protective ventilation) OR (PEEP)) OR (recruitment maneuver)) OR (low tidal volume) AND (2000:2024[pdat])) AND (pediatric) filters. In total, 1,106 articles were retrieved, with only 23 being deemed relevant to the review. Data extraction and analysis were conducted by two independent researchers to ensure accuracy and consistency. We conducted descriptive statistical analysis for quantitative data and thematic analysis for qualitative data. Key Content and Findings: , ultrasound-guided RM, target directed fluid infusion, adequate analgesia, and the use of HFNC in special circumstances. However, we also found that the application of LPV has certain potential risks and therefore needs to be implemented according to the patient's actual age and physical condition. Conclusions: , appear to be effective methods for protecting lung function in pediatric patients. Additionally, perioperative fluid management and effective pain control are crucial for lung protection. The emerging use of HFNC therapy shows promise, but further research is needed to fully understand its benefits.