Background

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_T) based on intratidal compliance profiles in healthy young children undergoing general anaesthesia.

Methods

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 H₂O/V_T 8 ml kg⁻¹ (PEEP8/V_T8), PEEP 10 cm H₂O/V_T 5 ml kg⁻¹ (PEEP10/V_T5), PEEP 10 cm H₂O/V_T 8 ml kg⁻¹ (PEEP10/V_T8), and PEEP 12 cm H₂O/V_T 5 ml kg⁻¹ (PEEP12/V_T5). 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.

Results

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_T5 (60.5%), compared with PEEP10/V_T8, PEEP8/V_T8, and PEEP12/V_T5 (23.3–34.9%; P<0.001). Decreasing compliance profiles were most frequent when V_T increased to 8 ml kg⁻¹, PEEP increased to 12 cm H₂O, or both. Plateau airway pressures were lower at PEEP8/V_T8 (16.9 cm H₂O [2.2]) and PEEP10/V_T5 (16.7 cm H₂O [1.7]), compared with PEEP10/V_T8 (19.5 cm H₂O [2.1]) and PEEP12/V_T5 (19.0 cm H₂O [2.0]; P<0.001). Driving pressure was lowest with PEEP10/V_T5 (4.6 cm H₂O), compared with other combinations (7.0 cm H₂O [2.0]–9.5 cm H₂O [2.1]; P<0.001).

Conclusions

V_T 5 ml kg⁻¹ combined with 10 cm H₂O 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_T settings on postoperative pulmonary complications in children undergoing surgery requires further study.

Clinical trial registration

NCT04633720.

中文翻译：

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通过潮内顺应性确定儿童最佳呼气末正压和潮气量：一项前瞻性观察研究

背景

关于儿科人群最佳术中通气策略的数据有限。本研究旨在根据接受全身麻醉的健康幼儿的潮内顺应性曲线确定 PEEP 和潮气量 (V _{T ) 的最佳组合。}

方法

在麻醉期间，婴儿（1 个月至 1 岁）、幼儿（1-3 岁）和儿童（3-6 岁）被连续分配到四种呼吸机设置：PEEP 8 cm H ₂ O/V _T 8 ml kg ^-1 (PEEP8/V _T 8), PEEP 10 cm H ₂ O/V _T 5 ml kg ^-1 (PEEP10/V _T 5), PEEP 10 cm H ₂ O/V _T 8 ml kg ^-1 (PEEP10/V _T 8 ) 和 PEEP 12 cm H ₂ O/V _T 5 ml kg ^-1 (PEEP12/V _T5）。主要结果是潮汐内顺应性曲线，在每个呼吸机设置下分类为水平（指示最佳肺泡通气条件）、增加、减少或增加/减少/水平顺应性的组合。次要结果是吸气峰压、平台压和驱动压。

结果

测量了 15 名婴儿、13 名幼儿和 15 名儿童（15/43 [35%] 女性）的潮内顺应性。_{与 PEEP10/V T} 8、PEEP8/V _T 8 和 PEEP12/V _T 5 (23.3–34.9%; P <0.001)相比，水平顺应性曲线最常观察到 PEEP10/V _T 5 (60.5% )。_{当 V T}增加到 8 ml kg ^-1，PEEP 增加到 12 cm H ₂ O，或两者兼有时，顺应性下降最常见。_{与 PEEP10/V T相比，PEEP8/V T} 8 (16.9 cm H ₂ O [2.2]) 和 PEEP10/V _T 5 (16.7 cm H ₂ O [1.7])的高原气道压力较低8 (19.5 cm H ₂ O [2.1]) 和 PEEP12/V _T 5 (19.0 cm H ₂ O [2.0]; P <0.001)。与其他组合相比（7.0 cm H ₂ O [2.0]–9.5 cm H ₂ O [2.1]；P <0.001） ，PEEP10/V _T 5 (4.6 cm H ₂ O)的驱动压力最低。

结论

V _T 5 ml kg ^-1联合 10 cm H ₂ O PEEP 可减少大多数机械通气儿童<6 岁的肺不张和过度扩张，并最大限度地降低驱动压力。这些 PEEP 和 V _T设置对接受手术的儿童术后肺部并发症的影响需要进一步研究。

临床试验注册

NCT04633720。