Hypoxic preconditioning improves intraoperative oxygenation and postoperative recovery in children undergoing thoracoscopic surgery: a randomized controlled trial.

BACKGROUND

Hypoxia preconditioning (HPC) and remote ischemic preconditioning (RIPC) are potential lung-protective strategies, but their efficacy in pediatric thoracic surgery remains unclear. This randomized controlled trial aimed to evaluate the effects of HPC, alone or in combination with RIPC, in children undergoing video-assisted thoracoscopic pulmonary resection.

METHODS

In a single-center, 2 × 2 factorial randomized trial, 160 children (<18 years) undergoing thoracoscopic lung surgery were allocated to four groups: Control (no preconditioning), HPC (three cycles of 5-min hypoxia/ventilation in the non-dependent lung), RIPC (three cycles of 5-min limb ischemia/reperfusion), and combined HPC + RIPC. The primary outcome was the PaO2/FiO2 ratio at 30 min of one-lung ventilation (OLV). Secondary outcomes included the duration of postoperative mechanical ventilation, hospital length of stay, and incidence of postoperative pulmonary complications (PPCs).

RESULTS

A total of 139 patients were included in the final analysis. Compared with the control group, HPC significantly improved oxygenation at 30 min of OLV (PaO2/FiO2: 256.4 ± 60.3 vs. 201.3 ± 65.0 mmHg; p = 0.022), reduced median mechanical ventilation duration (45 vs. 102.5 min; p < 0.001), and shortened hospital length of stay (7 vs. 11 days; p = 0.001). HPC also reduced the incidence of PPCs (53% vs. 81%; p = 0.021), with the largest reduction observed in pleural effusion. The addition of RIPC did not enhance these outcomes, and RIPC alone had no significant effect.

CONCLUSION

HPC was associated with improved intraoperative oxygenation and enhanced postoperative recovery in children undergoing thoracoscopic pulmonary surgery. These findings suggest that HPC may represent a simple and promising lung-protective strategy in pediatric thoracic anesthesia.

CLINICAL TRIAL REGISTRATION: Identifier ChiCTR2000038658, https://www.chictr.org.cn/showproj.html?proj=61845.