Related Experiment Video

Updated: Aug 8, 2026

Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome (ARDS)
06:22

Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome (ARDS)

Published on: April 7, 2021

Positive end-expiratory pressure and ventilation inhomogeneity in mechanically ventilated children

Andreas Schibler1, Robert Henning

  • 1Pediatric Intensive Care Unit, Royal Children's Hospital Melbourne, Melbourne, Australia.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|June 5, 2003
PubMed

Insights

Optimizing positive end-expiratory pressure (PEEP) in children with lung disease using functional residual capacity and ventilation homogeneity measurements improves gas exchange. This study demonstrates that sulfur hexafluoride wash-out technique aids in determining optimal PEEP levels for better patient outcomes.

Area of Science:

  • Pediatric critical care medicine
  • Respiratory physiology
  • Mechanical ventilation

Background:

  • Positive end-expiratory pressure (PEEP) is crucial for managing lung disease in children.
  • Determining optimal PEEP levels is challenging and impacts ventilation homogeneity and gas exchange.
  • Functional residual capacity (FRC) and ventilation distribution are key parameters to consider.

Purpose of the Study:

  • To investigate the optimal titration of PEEP in pediatric patients with lung disease.
  • To assess the utility of functional residual capacity and ventilation homogeneity measurements for PEEP optimization.
  • To evaluate the impact of PEEP on gas exchange and ventilation distribution using a sulfur hexafluoride wash-out technique.

Main Methods:

  • An experimental study involving 22 children (0-14 years) with lung disease and 7 rabbits.
  • Measurements of functional residual capacity and five indices of ventilation inhomogeneity were performed.
  • Subjects were exposed to varying levels of PEEP (0, 5, 10 cm H2O for children; 0, 3, 6 cm H2O for rabbits) using a sulfur hexafluoride wash-out technique.

Main Results:

  • In children, increasing PEEP significantly increased functional residual capacity and decreased ventilation inhomogeneity.
  • Alveolar mean dilution number and pulmonary clearance delay showed significant reductions with higher PEEP levels in children.
  • Improved Pao2 levels were observed with increasing PEEP, indicating enhanced gas exchange.
  • Similar trends of increased FRC and improved ventilation homogeneity were noted in rabbits.

Conclusions:

  • Optimal PEEP titration in children with lung disease can be achieved by measuring functional residual capacity and ventilation distribution.
  • The sulfur hexafluoride wash-in/wash-out technique is a valuable tool for assessing ventilation homogeneity and guiding PEEP selection.
  • These findings support a strategy of PEEP optimization based on physiological measurements to improve respiratory support in pediatric patients.

More Related Videos

Monitoring Lung Function with Electrical Impedance Tomography in the Intensive Care Unit05:56

Monitoring Lung Function with Electrical Impedance Tomography in the Intensive Care Unit

Published on: September 6, 2024

Inspiratory Muscle Training as an Adjunct to the Treatment of Weaning Failure in Critically Ill Patients: A Practical Guide04:16

Inspiratory Muscle Training as an Adjunct to the Treatment of Weaning Failure in Critically Ill Patients: A Practical Guide

Published on: January 30, 2026

Related Concept Videos

Pulmonary Cycle: Exhalation01:17

Pulmonary Cycle: Exhalation

In terms of human respiration, the act of expelling air, known as exhalation (or expiration), operates on the principle of pressure gradients. During expiration, the pressure within the lungs exceeds that of the surrounding atmosphere. Under normal conditions, quiet breathing involves passive exhalation and is free of muscular contractions. This is because the exhalation process is driven by the natural elastic recoil of the lungs and chest wall, both of which have an inherent tendency to...
Acute Respiratory Failure-II01:21

Acute Respiratory Failure-II

Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
Mechanical Ventilation I: Indication and Settings01:29

Mechanical Ventilation I: Indication and Settings

Mechanical ventilation is a life-saving technique for managing acute respiratory failure and other respiratory complications. The process involves using a machine known as a ventilator to supply oxygen to the lungs and assist in removing carbon dioxide. It serves as a bridge to long-term mechanical ventilation or a temporary measure until ventilatory support is discontinued. The ventilator can maintain this function for a prolonged period, providing critical support for patients until they can...
Mechanical Ventilation II: Invasive Ventilation01:23

Mechanical Ventilation II: Invasive Ventilation

Ventilators are essential medical equipment used to aid patients with respiratory difficulties. Their primary function is to assist or replace spontaneous breathing by providing mechanical ventilation. There are two general classes of mechanical ventilators: negative-pressure and positive-pressure ventilators.
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
Mechanical Ventilation III: Noninvasive Ventilation01:23

Mechanical Ventilation III: Noninvasive Ventilation

Noninvasive positive-pressure ventilation (NIPPV), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP) are essential methods in respiratory care. These ventilation techniques offer unique benefits for patients with various respiratory conditions, providing adequate support without requiring intubation. Let's explore how each method is crucial in improving patient outcomes and enhancing respiratory therapy.
Noninvasive Positive-Pressure Ventilation (NIPPV)
Ventilatory Modes01:14

Ventilatory Modes

Mechanical ventilators are life-saving devices that support or replace spontaneous breathing. They deliver breaths to patients through varying methods known as ventilator modes. Understanding these modes is critical for healthcare providers managing patients with respiratory failure.
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...