Lung ultrasound-guided recruitment for reducing perioperative atelectasis in patients with obesity undergoing laparoscopic surgery

This study aimed to evaluate the feasibility of lung ultrasound (LUS)-guided lung recruitment to reduce early postoperative atelectasis and to explore its short-term effects on oxygenation in patients with obesity undergoing laparoscopic surgery.

A total of 67 patients with obesity and a body mass index ≥ 28 kg/m² and American Society of Anesthesiologists classification I–III who underwent laparoscopic surgery were enrolled. Participants were randomly allocated to a control group (group C, n = 34; mechanical ventilation with a lung-protective strategy using 5 cm H₂O positive end-expiratory pressure [PEEP] without lung recruitment) or an experimental group (group LU, n = 33; LUS-guided lung recruitment combined with 5 cm H₂O PEEP). LUS scores, incidence and severity of atelectasis, hemodynamic changes, oxygenation index, and postoperative pulmonary complications (PPCs) were compared between the groups.

The incidence of perioperative atelectasis in patients with obesity approached 100%. LUS-guided lung recruitment combined with PEEP resulted in significantly lower LUS scores compared with PEEP alone (p < 0.05). Following extubation, the incidence of atelectasis was lower in group LU (36.36%) compared with group C (76.47%) (p < 0.05). Group LU also demonstrated significant improvement in oxygenation (p < 0.05); no significant differences were found in individual PPCs between the groups (p > 0.05), while total PPC events were significantly lower in group LU (p < 0.05).

LUS-guided recruitment is a feasible strategy for reducing early ultrasound-detected atelectasis after extubation in patients with obesity undergoing laparoscopic surgery, with a modest short-term improvement in oxygenation. The clinical relevance of these findings, particularly regarding postoperative pulmonary complications beyond 24 h, remains to be established in larger trials with clinically meaningful long-term endpoints.

The study adheres to CONSORT guidelines and was registered with the Chinese Clinical Trial Registry (ChiCTR2500107265). Although registration was completed retrospectively on August 7, 2025 (enrollment began October 2024), the protocol was prospectively approved by the Ethics Committee (KYLL-333) before enrollment. All outcomes were prespecified and unchanged.