Positive end-expiratory pressure improves elastic working pressure in anesthetized children

Abstract

BackgroundPositive end-expiratory pressure (PEEP) has been demonstrated to decrease ventilator-induced lung injury in patients under mechanical ventilation (MV) for acute respiratory failure. Recently, some studies have proposed some beneficial effects of PEEP in ventilated patients without lung injury. The influence of PEEP on respiratory mechanics in children is not well known. Our aim was to determine the effects on respiratory mechanics of setting PEEP at 5 cmH2O in anesthetized healthy children.MethodsPatients younger than 15 years old without history of lung injury scheduled for elective surgery gave informed consent and were enrolled in the study. After usual care for general anesthesia, patients were placed on volume controlled MV. Two sets of respiratory mechanics studies were performed using inspiratory and expiratory breath hold, with PEEP 0 and 5 cmH2O. The maximum inspiratory and expiratory flow (QI and QE) as well as peak inspiratory pressure (PIP), plateau pressure (PPL) and total PEEP (tPEEP) were measured. Respiratory system compliance (CRS), inspiratory and expiratory resistances (RawI and RawE) and time constants (KTI and KTE) were calculated. Data were expressed as median and interquartile range (IQR). Wilcoxon sign test and Spearman’s analysis were used. Significance was set at P < 0.05.ResultsWe included 30 patients, median age 39 (15–61.3) months old, 60% male. When PEEP increased, PIP increased from 12 (11,14) to 15.5 (14,18), and CRS increased from 0.9 (0.9,1.2) to 1.2 (0.9,1.4) mL·kg− 1·cmH2O− 1; additionally, when PEEP increased, driving pressure decreased from 6.8 (5.9,8.1) to 5.8 (4.7,7.1) cmH2O, and QE decreased from 13.8 (11.8,18.7) to 11.7 (9.1,13.5) L·min− 1 (all P < 0.01). There were no significant changes in resistance and QI.ConclusionsAnalysis of respiratory mechanics in anesthetized healthy children shows that PEEP at 5 cmH2O places the respiratory system in a better position in the P/V curve. A better understanding of lung mechanics may lead to changes in the traditional ventilatory approach, limiting injury associated with MV.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0611-8) contains supplementary material, which is available to authorized users.

Driving Pressure and Normalized Energy Transmission Calculations in Mechanically Ventilated Children Without Lung Disease and Pediatric Acute Respiratory Distress Syndrome*

“…This study is a post hoc analysis of individual patient data from two previously published studies by our team regards the respiratory system mechanics in ventilated children: 1) children under general anesthesia without an acute pulmonary disease (ANESTH group) (10) and 2) children who met PARDS diagnostic criteria in a cohort of 54 mechanically ventilated patients registered in a database (11). In both groups, patients were excluded if they had uncorrected congenital heart disease, preexisting lung or airway disease, conditions capable of reducing chest wall compliance, chronic respiratory failure requiring long-term MV, and tracheostomy.…”

Flow-controlled ventilation maintains gas exchange and lung aeration in a pediatric model of healthy and injured lungs: A randomized cross-over experimental study

“…Furthermore, increased chest-wall compliance and enhanced elastic recoil of lung parenchyma make children more prone to developing atelectasis and ventilation heterogeneity than adults (3). Various modalities have been recently suggested to tackle this challenge without increasing the risk of excessive lung tissue stress and strain (4)(5)(6) in both healthy and injured lungs.…”

The Stepwise Slow Titration of Positive End-Expiratory Pressure Before the End of General Anaesthesia Improves Lung Mechanics in Children: A Randomized Open Label Clinical Trial

“…When it comes to children with healthy lungs and idea of preventive role of PEEP literature data are limited. Recently, Cruces et al (19) demonstrated that application of PEEP 5 cmH 2 O in children up to Iran J Pediatr. 2020; 30(4):e101801.…”