Optimal Ventilation of the Anesthetized Pediatric Patient

Feldman, Jeffrey M.

doi:10.1213/ane.0000000000000472

Cited by 61 publications

(69 citation statements)

References 22 publications

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“…Modern anesthesia machines and ventilators are designed to deliver more accurate TV by compensating for circuit compliance . Our data are consistent with a previous study of VCV of test lungs with small TV, which demonstrated that both the absence of circuit compliance compensation and changes in circuit tubing compliance following the preuse self‐test resulted in discrepancies between delivered and displayed TV …”

Section: Discussionsupporting

confidence: 88%

“…Anesthesia machines have evolved to deliver more accurate tidal volume (TV) by calculating and incorporating breathing circuit compliance . The circuit compliance is measured automatically during the electronic preuse self‐test and is subsequently used for the remainder of the case regardless of whether the actual compliance of the breathing circuit changes.…”

Section: Introductionmentioning

confidence: 99%

“…Mechanical ventilation in the infant patient has long been acknowledged to be a challenging endeavor. As infants require much smaller TV than adults, small changes in TV or airway pressures can have significant effects on minute ventilation and risk of suboptimal ventilation or lung damage . When utilizing mechanical ventilation on an infant, it is imperative to avoid volutrauma and barotrauma, as well as extremes in hyper‐ and hypoventilation.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Breathing circuit compliance and accuracy of displayed tidal volume during pressure‐controlled ventilation of infants: A quality improvement project

Glenski

Diehl

Clopton

et al. 2017

Pediatric Anesthesia

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Performing a preuse self-test on a nonexpanded pediatric circuit that is then expanded leads to falsely elevated displayed tidal volume in infants less than 10 kg during pressure-controlled ventilation. Overestimation of reported tidal volume can be avoided by expanding the breathing circuit tubing to the length which will be used during a case prior to performing the anesthesia machine preuse self-test. After department-wide education and implementation, performing a correct preuse self-test is now the standard practice in our cardiac operating rooms.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Breathing circuit compliance and accuracy of displayed tidal volume during pressure‐controlled ventilation of infants: A quality improvement project

Glenski

Diehl

Clopton

et al. 2017

Pediatric Anesthesia

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“…Spirometric monitoring during anaesthesia allows for precise measurements of gas flows, airway pressures and tidal volumes (V T ). The delivery of V T within a narrow range during volume‐targeted ventilation is essential for lung‐protective approaches in adults and children , and necessary to reduce morbidity and mortality in patients with mechanically ventilated lungs . Neonates have a greater risk of developing ventilator‐induced lung injury due to their immature respiratory tract .…”

Section: Introductionmentioning

confidence: 99%

Accuracy of near‐patient vs. inbuilt spirometry for monitoring tidal volumes in an in‐vitro paediatric lung model

Morgenroth¹,

Thomas²,

Cannizzaro³

et al. 2018

Anaesthesia

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Spirometric monitoring provides precise measurement and delivery of tidal volumes within a narrow range, which is essential for lung-protective strategies that aim to reduce morbidity and mortality in mechanically-ventilated patients. Conventional anaesthesia ventilators include inbuilt spirometry to monitor inspiratory and expiratory tidal volumes. The GE Aisys CS anaesthesia ventilator allows additional near-patient spirometry via a sensor interposed between the proximal end of the tracheal tube and the respiratory tubing. Near-patient and inbuilt spirometry of two different GE Aisys CS anaesthesia ventilators were compared in an in-vitro study. Assessments were made of accuracy and variability in inspiratory and expiratory tidal volume measurements during ventilation of six simulated paediatric lung models using the ASL 5000 test lung. A total of 9240 breaths were recorded and analysed. Differences between inspiratory tidal volumes measured with near-patient and inbuilt spirometry were most significant in the newborn setting (p < 0.001), and became less significant with increasing age and weight. During expiration, tidal volume measurements with near-patient spirometry were consistently more accurate than with inbuilt spirometry for all lung models (p < 0.001). Overall, the variability in measured tidal volumes decreased with increasing tidal volumes, and was smaller with near-patient than with inbuilt spirometry. The variability in measured tidal volumes was higher during expiration, especially with inbuilt spirometry. In conclusion, the present in-vitro study shows that measurements with near-patient spirometry are more accurate and less variable than with inbuilt spirometry. Differences between measurement methods were most significant in the smallest patients. We therefore recommend near-patient spirometry, especially for neonatal and paediatric patients.

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“…For those infants with lung disease of prematurity, respiratory distress syndrome, or other conditions like pulmonary hypertension, precise ventilation is important to ensuring the best outcome. To ensure optimal ventilation, the pediatric anesthetist must select their equipment carefully, tailor the ventilator settings to the needs of the individual patient and monitor the interaction between ventilator and patient …”

Section: Introductionmentioning

confidence: 99%

Optimal management of apparatus dead space in the anesthetized infant

King

Feldman

2017

Pediatric Anesthesia

Self Cite

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Mechanical ventilation of the anesthetized infant requires careful attention to equipment and ventilator settings to assure optimal gas exchange and minimize the potential for lung injury. Apparatus dead space, defined as dead space resulting from devices placed between the endotracheal tube and the Y-piece of the breathing circuit, is the primary source of dead space controlled by the clinician. Due to the small tidal volumes required by infants and neonates, it is easy to create excessive apparatus dead space resulting in unintended hypercarbia or increased minute ventilation in an effort to achieve a desirable PCO . The goal of this review was to evaluate the apparatus that are commonly added to the breathing circuit during anesthesia care, and develop recommendations to guide the clinician in selecting apparatus that are best matched to the clinical goals and the patient's size. We include specific recommendations for apparatus that are best suited for different size pediatric patients, with a particular focus on patients <5 kg.

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Optimal Ventilation of the Anesthetized Pediatric Patient

Cited by 61 publications

References 22 publications

Breathing circuit compliance and accuracy of displayed tidal volume during pressure‐controlled ventilation of infants: A quality improvement project

Breathing circuit compliance and accuracy of displayed tidal volume during pressure‐controlled ventilation of infants: A quality improvement project

Accuracy of near‐patient vs. inbuilt spirometry for monitoring tidal volumes in an in‐vitro paediatric lung model

Optimal management of apparatus dead space in the anesthetized infant

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