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Negative extra-abdominal pressure (NEXAP)-based lung recruitment maneuver versus standard lung recruitment maneuver in the treatment of postoperative atelectasis after cardiac surgery: A single-center randomized controlled trial
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Negative extra-abdominal pressure (NEXAP)-based lung recruitment maneuver versus standard lung recruitment maneuver in the treatment of postoperative atelectasis after cardiac surgery: A single-center randomized controlled trial
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Negative extra-abdominal pressure (NEXAP)-based lung recruitment maneuver versus standard lung recruitment maneuver in the treatment of postoperative atelectasis after cardiac surgery: A single-center randomized controlled trial
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Journal Article
Negative extra-abdominal pressure (NEXAP)-based lung recruitment maneuver versus standard lung recruitment maneuver in the treatment of postoperative atelectasis after cardiac surgery: A single-center randomized controlled trial
2025
Overview
To evaluate the effect of negative extra-abdominal pressure (NEXAP)-based lung recruitment maneuver (LRM) for atelectasis after cardiac surgery, and compare it with stepwise positive end-expiratory pressure (PEEP)-based LRM.
In this single-center randomized controlled clinical trial, patients were assigned to the NEXAP or PEEP groups. The primary outcome was the lung ultrasound score (LUSS) on global (LUSStot) and regional (LUSSp, posterior, LUSSa, anterior and LUSSl, lateral regions).
29 patients in the NEXAP group and 33 patients in the PEEP group were analyzed. The LUSStot was significantly decreased after LRM in both the NEXAP group (20.7 ± 3.2 vs. 15.6 ± 3.3; p < 0.001) and PEEP group (21.5 ± 4.2 vs. 17.1 ± 4.6; p < 0.001), and ΔLUSStot was significantly greater in the NEXAP group than PEEP group (−5.1 ± 2.3 vs. −3.8 ± 2.2, p = 0.020). Regional LUSS showed that NEXAP reduced LUSSl and LUSSp. PaO2/FiO2, PaO2, Vt, and Crs were significantly improved in the two groups.
NEXAP is an effective treatment for atelectasis after cardiac surgery, which significantly reduced patients' LUSS, improved pulmonary ventilation (especially in the lateral and posterior regions). NEXAP can further reduce LUSStot than the traditional PEEP-based LRM. Regional LUSS analyses reflecting the different mechanisms between the two methods of LRMs may require further investigation.
•Negative extra-abdominal pressure-based lung recruitment maneuver is effective for atelectasis after cardiac surgery.•First application of extra-abdominal pressure-based lung recruitment in a clinical population.•Negative extra-abdominal pressure-based lung recruitment can reduce the lung ultrasound score compared to traditional method.•Regional lung ultrasound analyses reflecting the different mechanisms between the two methods of recruitment maneuver.•Negative extra-abdominal pressure-based lung recruitment maneuver has less haemodynamic impact than traditional method.
Publisher
Elsevier Inc,Elsevier Limited
Subject
/ Aged
/ Cardiac Surgical Procedures - adverse effects
/ Cardiopulmonary resuscitation
/ CPR
/ Evidence
/ Female
/ Humans
/ Male
/ Negative extra-abdominal pressure
/ Patients
/ Positive-Pressure Respiration - methods
/ Postoperative Complications - therapy
/ Pulmonary Atelectasis - diagnostic imaging
/ Pulmonary Atelectasis - etiology
