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Lung function in the supine and lateral decubitus positions in anaesthetized infants and children
A Larsson1, C Jonmarker, S G Lindahl
1Department of Anaesthesia, University Hospital, Lund, Sweden.
Insights
In anesthetized children, changing to the lateral position increased functional residual capacity (FRC). Spontaneously breathing children showed impaired pulmonary gas mixing in this position.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Physiology
Background:
- Understanding lung function in children under anesthesia is crucial for patient safety.
- Positional changes can significantly impact respiratory mechanics and gas exchange.
Purpose of the Study:
- To evaluate the effects of the lateral decubitus position on lung mechanics and gas mixing in anesthetized children.
- To compare findings between spontaneously breathing and mechanically ventilated children.
Main Methods:
- Measurements included dynamic/static lung compliance, functional residual capacity (FRC), pulmonary clearance delay (PCD), and single breath alveolar mixing efficiency (SBAME).
- 25 children (5 months-9 years) were studied in supine and lateral positions under nitrous oxide-halothane anesthesia.
- Data were collected from both spontaneously breathing and mechanically ventilated pediatric patients.
Main Results:
- Functional residual capacity (FRC) significantly increased in the lateral position for both spontaneously breathing (22 to 25 ml kg-1) and mechanically ventilated (19 to 24 ml kg-1) groups.
- Lung compliance showed no significant change with positional alteration.
- Spontaneously breathing children exhibited impaired pulmonary gas mixing (PCD, SBAME) in the lateral position (P < 0.05), unlike mechanically ventilated children.
Conclusions:
- The lateral decubitus position increases FRC in anesthetized children.
- Pulmonary gas mixing may be compromised in spontaneously breathing children in the lateral position.
- Ventilation distribution in anesthetized children in the lateral position appears similar to that in adults.
Abstract:
We have measured dynamic lung compliance or static lung thorax compliance, functional residual capacity (FRC), and two indices of pulmonary gas mixing (pulmonary clearance delay (PCD) and single breath alveolar mixing efficiency (SBAME)) in 25 children in the supine and lateral decubitus position during nitrous oxide-halothane anaesthesia. Fifteen children (5 month-8 yr) breathed spontaneously and 10 (4 month-9 yr) underwent mechanical ventilation. Tidal volume and rate of ventilation were, respectively, 3.5-6.6 ml kg-1 and 22-46 b.p.m. in spontaneously breathing supine children, and 8.3-15 ml kg-1 and 20-30 b.p.m. in mechanically ventilated supine children, and did not differ significantly in the lateral position. There was no significant change in compliance when the child was turned to the lateral position, but FRC increased from 22 (SD7) to 25 (8) ml kg-1 (P less than 0.01) in the spontaneously breathing group and from 19 (6) to 24 (8) ml kg-1 (P less than 0.01) in the other group. In spontaneously breathing children, PCD and SBAME indicated a somewhat impaired pulmonary gas mixing (P less than 0.05) after the child had been turned to the lateral position, but no change occurred in the other group. These findings suggest that the distribution of ventilation in anaesthetized children in the lateral position is similar to that reported previously in anaesthetized adults.