Continuous Respiratory Oscillometry in Pediatric Laparoscopic Surgery—The COMET Study

BACKGROUND: Laparoscopic appendectomy is the accepted surgical approach for appendicitis in centers worldwide. Laparoscopic surgery requires the creation of a pneumoperitoneum to facilitate surgical access. Laparoscopic surgery affects the respiratory mechanics of patients under general anesthesia. In pediatric patients, there is very little published data that has investigated this effect. AIMS: This feasibility study aims to determine whether it is possible to continually track the respiratory mechanics of patients undergoing laparoscopic appendectomy utilizing respiratory oscillometry. METHODS: Single center, prospective, observational feasibility study conducted at a Tertiary Pediatric center in Western Australia, between May 2020 and April 2023. Patients with known difficult airways, thoracic malformations, and severe cardiopulmonary disease were excluded. Respiratory oscillometry was utilized to measure Reactance (Xrs) and Resistance (Rrs) in all patients to determine the effects of pneumoperitoneum on the respiratory mechanics at specific time points through the surgical procedure. RESULTS: One hundred & Fifty-Four (154) pediatric patients, male & female, between the ages of 2-16 years, undergoing laparoscopic appendectomy were approached. One hundred were recruited to the study with 99 included in the final analysis. Feasibility was demonstrated in terms of both patient acceptance (65% recruitment rate) and the collection of acceptable, usable and reproducible data from 80% of recruited patients. CONCLUSION: The utilization of respiratory oscillometry has previously been described in pediatric literature, but this has been limited to studies of isolated points in time. This study has demonstrated that it is both feasible and acceptable to continuously measure respiratory mechanics in pediatric patients and that future larger randomized control trials are warranted based on these findings. TRIAL REGISTRATION: ANZCTR 12620000380998.