Respiratory failure & ventilation
Effect of recruitment maneuver strategy on early postoperative atelectasis among intermediate- to high-risk patients undergoing abdominal surgery: A multicenter, 2 × 2 factorial, randomized clinical trial
Primary result · Early postoperative atelectasisResult — go to the resultRelative risk 0.67 95% CI 0.53–0.83Authors' conclusion
Among intermediate- to high-risk patients undergoing abdominal surgery, recruitment maneuver under ultrasound guidance significantly reduced early postoperative atelectasis versus conventional technique, while both stepwise and sustained lung inflation can be used alternatively for achieving a recruitment maneuver.
Study context
- Population
- Adults at intermediate to high risk of pulmonary complications scheduled for abdominal surgery of anticipated duration ≥2 h, six tertiary hospitals in China
- Participants
- 353 adults
- Comparison
- Ultrasound guidance vs Conventional technique
- Primary endpoint
- Incidence of early postoperative atelectasis (lung ultrasound)
- Follow-up
- 30 min after tracheal extubation
Methodological detailsmulticentre, 2 × 2 factorial, April 2024 to October 2024; all patients received lung-protective ventilation
- Multicentre
- 2 × 2 factorial
- April 2024 to October 2024; all patients received lung-protective ventilation
Primary result
Early postoperative atelectasis
Relative risk
0.67
95% CI 0.53–0.83
P < 0.001
Events by treatment group
Ultrasound guidance vs Conventional technique
RR 0.67 (95% CI 0.53–0.83); P < 0.001
As reported in the abstract
Secondary outcomes
| Outcome | Median difference (95% CI) | |
|---|---|---|
| Early postoperative lung ultrasound scoreUltrasound guidance vs Conventional technique | - 1 (−2 to 0) | |
| −3−2−101Difference (linear scale) |
| Outcome | RR (95% CI) | |
|---|---|---|
| HypoxemiaUltrasound guidance vs Conventional technique | 0.72 (0.58–0.88) | |
| Pulmonary complications · within 7 days postoperativelyUltrasound guidance vs Conventional technique | 0.78 (0.63–0.97) | |
| 0.512Relative risk (log scale) |
| Outcome | Median difference (mmHg) (95% CI) | |
|---|---|---|
| Oxygenation indexUltrasound guidance vs Conventional technique | 21.7 (0.5–42.1) | |
| −200204060Difference, mmHg (linear scale) |
| Outcome | Median difference (yuan) (95% CI) | |
|---|---|---|
| Hospitalization costUltrasound guidance vs Conventional technique | - 3586 (−7084 to −313) | |
| −10000−500005000Difference, yuan (linear scale) |
Secondary outcomes, stepwise vs sustained inflation
- No significant differences
Original publication
Effect of recruitment maneuver strategy on early postoperative atelectasis among intermediate- to high-risk patients undergoing abdominal surgery: A multicenter, 2 × 2 factorial, randomized clinical trial. J Clin Anesth. Published 21 February 2026. doi:10.
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