Preconditioning lung collapse: effects of early recruitment maneuvers on lung deflation dynamics during one-lung ventilation.

Abstract

Rapid and adequate lung collapse is essential for optimal surgical exposure during video-assisted thoracoscopic surgery (VATS). Although recruitment maneuvers (RMs) are widely used to improve alveolar aeration, whether their application immediately after tracheal intubation facilitates lung collapse during one-lung ventilation remains uncertain. This randomized controlled trial evaluated the effects of immediate post-intubation RMs on lung collapse dynamics, perioperative oxygenation, and postoperative pulmonary complications. Sixty adult patients undergoing elective VATS were randomized to a recruitment maneuver group (RM, <i>n</i>&#x202f;=&#x202f;30) or a control group (<i>n</i>&#x202f;=&#x202f;30). The RM group received standardized recruitment maneuvers after double-lumen tube intubation, whereas the control group same standardized ventilatory strategy without recruitment maneuvers. Lung collapse quality was assessed using the Campos score after pleural opening. Time to complete lung collapse, surgeon-rated satisfaction, arterial blood gasses and postoperative pulmonary complications within 7&#x202f;days were recorded (ChiCTR2300075148). Compared with standardized ventilatory strategy, immediate post-intubation RMs significantly shortened the time to complete lung collapse (14.4&#x202f;&#xb1;&#x202f;3.3&#x202f;min vs. 16.9&#x202f;&#xb1;&#x202f;3.7&#x202f;min, <i>p</i>&#x202f;=&#x202f;0.008). The RM group demonstrated superior early lung collapse quality, reflected by higher Campos scores within 5-15&#x202f;min after pleural opening and greater surgeon-rated satisfaction. Oxygenation was higher in RM group at 15&#x202f;min of one-lung ventilation. The incidence of postoperative pulmonary complications was similar between groups. Recruitment maneuvers performed immediately after intubation were associated with accelerated lung collapse and improved early lung collapse quality. These findings support a potential role for early recruitment maneuvers in optimizing early surgical exposure during one-lung ventilation. https://www.chictr.org.cn/, ChiCTR2300075148.