The Effects of a Pre-Extubation Single Recruitment Maneuver on Ultrasonographic Lung Conditions in Patients Undergoing Lateral Decubitus Surgery: A Randomized Clinical Trial

Background: Upper abdominal surgeries exceeding two hours and operated in a lateral decubitus position present an “intermediate” risk for pulmonary complications. The objectives of this study were to observe the sonographic and clinical changes during and after surgeries with one recruitment maneuver (RM) performed intraoperatively before extubation. Methods: Laparoscopic nephrectomy patients were randomized into pre-extubation single RM (Group RM) and control (Group NoRM) groups. The LUS (Lung Ultrasound Score) was evaluated after intubation (T1), at the end of surgery before the RM (T2), after the RM but before extubation (T3), and 30 min after arrival to the Post-Anesthesia Care Unit (T4) in Group RM; in Group NoRM, it was evaluated at the T1, T2, and T4 time points. The primary outcome was the effect on the pre-extubation LUS (T2 in Group NoRM versus T3 in Group RM). The secondary outcomes included the effects on the T4 LUS, PPC occurrence, and PaO₂/FiO₂ ratios, and the sensitivity and specificity of the LUS in predicting PPCs. Results: The data of 54 patients were analyzed. The pre-extubation LUS was significantly lower in Group RM (16 (12.5, 17) vs. 18 (17, 20), p < 0.001). The T4 LUS was only different in the upper zones in the dependent lung (2 (1, 3.5) in Group RM vs. 4 (3, 4.5) in Group NoRM, p = 0.01). The perioperative PaO₂/FiO₂ ratios were similar (p > 0.05). The pre-extubation LUS exhibited 91% sensitivity (p = 0.04), whereas the T4 LUS sensitivity was 82% (p = 0.01). The PPC risk was 10-fold higher in patients with a pre-extubation LUS exceeding 19. Conclusions: A pre-extubation single RM instantly increases the LUS. However, this does not persist postoperatively or diminish respiratory complications. More importantly, the LUS was found to be a sensitive tool for predicting PPCs when performed just before extubation.