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Effects of Periodic Recruitment Maneuvers on Atelectasis and Respiratory Mechanics During Elective Spine Surgery Assessed by Lung Ultrasonography
Sponsor: Prof. Dr. Cemil Tascıoglu Education and Research Hospital Organization
Summary
During general anesthesia, particularly in patients undergoing spine surgery in the prone (face-down) position, increased intrathoracic and abdominal pressure may reduce lung compliance and promote the development of atelectasis (partial lung collapse). Atelectasis can impair intraoperative oxygenation and may increase the risk of postoperative pulmonary complications. Alveolar recruitment maneuvers (ARM) are routinely used in anesthesia practice to reopen collapsed lung regions; however, it remains unclear whether periodic application of ARM throughout surgery provides additional benefit compared with standard single-time application. This prospective, randomized controlled clinical study aims to evaluate whether periodic alveolar recruitment maneuvers applied during elective spine surgery in the prone position reduce intraoperative atelectasis and improve respiratory mechanics compared with the standard approach of performing ARM only after positioning and before extubation. Adult patients undergoing elective spine surgery under general anesthesia will be randomly assigned to either a periodic ARM group or a standard ARM group. Lung aeration will be assessed using lung ultrasound, a non-invasive and radiation-free bedside imaging method. The primary outcome is the incidence of intraoperative atelectasis assessed before extubation. Secondary outcomes include lung ultrasound aeration scores, respiratory mechanics parameters (such as airway pressures and compliance), oxygenation indices, and the occurrence of transient intraoperative respiratory or hemodynamic events. The findings of this study may help optimize intraoperative ventilation strategies in prone spine surgery and contribute to improved perioperative respiratory safety.
Official title: Evaluation of the Effects of Periodic Recruitment Maneuvers on Atelectasis and Respiratory Mechanics in Elective Spine Surgery Using Lung Ultrasonography
Key Details
Gender
All
Age Range
18 Years - 65 Years
Study Type
INTERVENTIONAL
Enrollment
60
Start Date
2026-04
Completion Date
2026-07
Last Updated
2026-04-08
Healthy Volunteers
No
Interventions
Alveolar Recruitment Maneuver
Alveolar recruitment maneuvers will be performed under general anesthesia using standard mechanical ventilation techniques within routine clinical safety limits. After prone positioning, a baseline recruitment maneuver will be applied by stepwise increasing positive end-expiratory pressure (PEEP) from 8 cmH₂O to 10 cmH₂O and 15 cmH₂O while maintaining an upper airway pressure limit of ≤30 cmH₂O for approximately 10 seconds. Following the maneuver, mechanical ventilation will continue with a PEEP level of approximately 8 cmH₂O according to routine clinical practice. In the periodic recruitment group, additional recruitment maneuvers will be repeated approximately once per hour during the intraoperative period. In the standard recruitment group, no additional intraoperative maneuvers will be applied apart from a final recruitment maneuver performed before extubation as part of routine anesthetic care.
Locations (1)
Prof. Dr. Cemil Tascıoglu Education and Research Hospital Organization
Istanbul, Turkey (Türkiye)