Determining optimal positive end-expiratory pressure and tidal volume in children by intratidal compliance: a prospective observational study.
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 34686309.
- Also identified by DOI 10.1016/j.bja.2021.09.024.
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Abstract
Limited data exist regarding optimal intraoperative ventilation strategies for the paediatric population. This study aimed to determine the optimal combination of PEEP and tidal volume (V<sub>T</sub>) based on intratidal compliance profiles in healthy young children undergoing general anaesthesia. During anaesthesia, infants (1 month-1 yr), toddlers (1-3 yr), and children (3-6 yr) were assigned serially to four ventilator settings: PEEP 8 cm H<sub>2</sub>O/V<sub>T</sub> 8 ml kg<sup>-1</sup> (PEEP8/V<sub>T</sub>8), PEEP 10 cm H<sub>2</sub>O/V<sub>T</sub> 5 ml kg<sup>-1</sup> (PEEP10/V<sub>T</sub>5), PEEP 10 cm H<sub>2</sub>O/V<sub>T</sub> 8 ml kg<sup>-1</sup> (PEEP10/V<sub>T</sub>8), and PEEP 12 cm H<sub>2</sub>O/V<sub>T</sub> 5 ml kg<sup>-1</sup> (PEEP12/V<sub>T</sub>5). The primary outcome was intratidal compliance profile, classified at each ventilator setting as horizontal (indicative of optimal alveolar ventilatory conditions), increasing, decreasing, or combinations of increasing/decreasing/horizontal compliance. Secondary outcomes were peak inspiratory, plateau, and driving pressures. Intratidal compliance was measured in 15 infants, 13 toddlers, and 15 children (15/43 [35%] females). A horizontal compliance profile was most frequently observed with PEEP10/V<sub>T</sub>5 (60.5%), compared with PEEP10/V<sub>T</sub>8, PEEP8/V<sub>T</sub>8, and PEEP12/V<sub>T</sub>5 (23.3-34.9%; P<0.001). Decreasing compliance profiles were most frequent when V<sub>T</sub> increased to 8 ml kg<sup>-1</sup>, PEEP increased to 12 cm H<sub>2</sub>O, or both. Plateau airway pressures were lower at PEEP8/V<sub>T</sub>8 (16.9 cm H<sub>2</sub>O [2.2]) and PEEP10/V<sub>T</sub>5 (16.7 cm H<sub>2</sub>O [1.7]), compared with PEEP10/V<sub>T</sub>8 (19.5 cm H<sub>2</sub>O [2.1]) and PEEP12/V<sub>T</sub>5 (19.0 cm H<sub>2</sub>O [2.0]; P<0.001). Driving pressure was lowest with PEEP10/V<sub>T</sub>5 (4.6 cm H<sub>2</sub>O), compared with other combinations (7.0 cm H<sub>2</sub>O [2.0]-9.5 cm H<sub>2</sub>O [2.1]; P<0.001). V<sub>T</sub> 5 ml kg<sup>-1</sup> combined with 10 cm H<sub>2</sub>O PEEP may reduce atelectasis and overdistension, and minimise driving pressure in the majority of mechanically ventilated children <6 yr. The effect of these PEEP and V<sub>T</sub> settings on postoperative pulmonary complications in children undergoing surgery requires further study. NCT04633720.
Medical subject headings
- Positive-Pressure Respiration
- Postoperative Complications
- Respiration, Artificial
- Tidal Volume