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Effect of low tidal volume with PEEP on respiratory function in infants undergoing one-lung ventilation

Jing Liu1, Xinfang Liao2, Yongle Li1

  • 1Department of Anesthesiology, Gangdong Women and Children Hospital, 510010, Gangzhou, China.

Der Anaesthesist
|June 29, 2017
PubMed

Insights

Low tidal volume (TV) with positive end-expiratory pressure (PEEP) ventilation may protect infant lungs during one-lung ventilation (OLV). This strategy showed potential benefits in reducing lung injury risk during thoracoscopic surgery.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Respiratory Physiology

Background:

  • Low tidal volume (TV) with positive end-expiratory pressure (PEEP) is recognized for lung protection during one-lung ventilation (OLV).
  • Infants have unique physiological characteristics necessitating tailored ventilation strategies.
  • The feasibility of low TV with PEEP in infants during OLV for thoracoscopy requires investigation.

Purpose of the Study:

  • To determine the feasibility and effect of low TV with PEEP in infants undergoing OLV.
  • To compare lung protection strategies during thoracoscopic procedures in infants.

Main Methods:

  • Sixty infants were randomized into a conventional group (TV 8-10 ml/kg, PEEP 0 cmH2O) or a low TV group (TV 5-7 ml/kg, PEEP 4-6 cmH2O).
  • Arterial blood gas, hemodynamic, and ventilation parameters were recorded at multiple time points.
  • Lung compliance and intrapulmonary shunt were calculated.

Main Results:

  • Both groups showed increased PCO2, peak airway pressure (Pmax), and shunt (Qs/Qt), with decreased PaO2 and compliance during OLV.
  • The low TV with PEEP group exhibited lower Pmax and shunt, but higher PCO2 and compliance compared to the conventional group.
  • No significant differences in lactic acid or PaO2 were observed between groups.

Conclusions:

  • Low TV with PEEP is a potentially effective intraoperative ventilation strategy for infants during OLV.
  • This approach may reduce the risk of lung injury in pediatric thoracoscopic surgery.
  • Further research is needed to fully understand the implications of intraoperative hypercapnia in infants using this strategy.
Abstract

Keywords:
Blood gas analysisLung complianceLung injuryPulmonary shuntVideo-assisted thoracoscopic surgery

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