Ventilation in pediatric anesthesia: A French multicenter prospective observational study (PEDIAVENT)

Area of Science:

• Anesthesiology
• Pediatric Critical Care
• Respiratory Physiology

Background:

• Protective ventilation is standard for adults but not children.
• Mechanical ventilation in pediatric anesthesia lacks standardized management.
• Understanding current pediatric ventilation practices is crucial.

Purpose of the Study:

• To evaluate current ventilatory practices in French pediatric anesthesia.
• To compare actual practices with expert recommendations, focusing on tidal volume.
• To identify factors influencing tidal volume delivery in children.

Main Methods:

• Prospective, multicenter observational study over two days in 29 French pediatric centers.
• Included children undergoing general anesthesia, excluding those on extracorporeal circulation or one-lung ventilation.
• Collected data on mechanical ventilation parameters, including tidal volume and positive end-expiratory pressure.

Main Results:

• 49.3% of children received expired tidal volume >8 mL/kg; 8.8% received ≥10 mL/kg.
• Lower weight and supraglottic airway use were linked to higher tidal volumes (≥10 mL/kg).
• Positive end-expiratory pressure varied, with 15.7% <3 cmH2O and 9.3% not used.

Conclusions:

• Pediatric ventilation practices are heterogeneous across centers.
• A significant proportion of children did not receive ventilation aligned with expert recommendations.
• Further research is needed to standardize pediatric mechanical ventilation.