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Pressure versus volume-controlled ventilation with a laryngeal mask airway in paediatric patients

I Keidan1, H Berkenstadt, E Segal

  • 1Department of Anesthesiology and Intensive Care, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel. keidan@shani.net

Paediatric Anaesthesia
|November 7, 2001
PubMed

Insights

Pressure-controlled ventilation (PCV) with a laryngeal mask airway (LMA) in children resulted in lower peak airway pressures than volume-controlled ventilation (VCV). This offers a safer option for pediatric anesthesia, reducing the risk of gastric insufflation.

Area of Science:

  • Anesthesiology
  • Pediatric critical care
  • Respiratory physiology

Background:

  • Positive pressure ventilation with laryngeal mask airway (LMA) in children can lead to high peak airway pressures, increasing the risk of gastric insufflation.
  • Comparing ventilation modes is crucial for optimizing pediatric anesthesia safety and efficacy.

Purpose of the Study:

  • To compare pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) in pediatric patients undergoing anesthesia with an LMA.
  • To assess peak inspiratory pressures, air leak, and signs of gastric insufflation between PCV and VCV.

Main Methods:

  • A prospective study involving 32 pediatric patients (4.5 +/- 4 years) scheduled for elective procedures.
  • Patients received both PCV and VCV sequentially after LMA insertion.
  • Ventilation was adjusted to maintain adequate end-tidal CO2 levels (5-5.4 kPa).

Main Results:

  • PCV demonstrated significantly lower peak airway pressures (14.1 +/- 1.6 cmH2O) compared to VCV (16.7 +/- 2.3 cmH2O).
  • Fewer patients required peak pressures >20 cmH2O with PCV (0) versus VCV (6).
  • Hemodynamic parameters, expiratory tidal volume, and air leak were similar; no gastric insufflation was observed in either group.

Conclusions:

  • PCV provides lower peak inspiratory pressures than VCV during pediatric anesthesia with an LMA, while maintaining comparable ventilation.
  • The reduced peak pressures with PCV may be particularly beneficial for pediatric patients with compromised chest wall or lung compliance.
  • Neither ventilation mode showed signs of gastric insufflation in this study.
Abstract

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