Effect of Lung-Protective Ventilation on Changes in Regional Cerebral Oxygen Saturation During Thoracoscopic Surgery in Children: A Prospective, Single-Center, Randomized Controlled Trial

Background: Low regional cerebral oxygen saturation (rScO2) in children is linked to neurological sequelae. Lung-protective ventilation (LPV) mitigates lung injury but its effect on intraoperative rScO2 is uncertain. Methods: One hundred and four children (<6 years) undergoing thoracoscopic mediastinal mass resection or lobectomy were randomized to LPV (n = 52; tidal volume: 6 mL/kg double-lung ventilation [DLV], 4 mL/kg one-lung ventilation [OLV] + 5 cm H2O PEEP) or Control (n = 52; 10 mL/kg DLV, 8 mL/kg OLV + zero PEEP). rScO2 was monitored continuously. Primary outcome was incidence of low rScO2 during OLV (≥20% decrease from baseline ≥1 min). Secondary outcomes included lowest rScO2, postoperative pulmonary complications (PPCs), and hospital length of stay (LOS). Results: Ninety-six children were analyzed (n = 48/group). Overall low rScO2 incidence during OLV was 25/96 (26%). Significantly low rScO2 incidence occurred with LPV (7/48, 14.6%) versus control (18/48, 37.5%; p = 0.011). The lowest intraoperative rScO2 was significantly higher in the LPV group 76.5 (70.3, 80.0) compared to control 70.5 (60.3, 76.0); p < 0.001. PPC incidence was lower with LPV (7/48, 14.6%) than control (16/48, 33.3%; p = 0.031). Postoperative LOS was shorter in the LPV group 4.0 [4.0–5.0] days versus control group 5.0 [4.3–6.0] days, p < 0.001. Conclusions: Compared to conventional ventilation, an LPV strategy significantly reduces the incidence of low rScO2 during OLV in young children undergoing thoracoscopic surgery. LPV also decreases PPCs and shortens hospital stay. Clinical trial registration: ChiCTR2400092732.