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Determining optimal positive end-expiratory pressure and tidal volume in children by intratidal compliance: a

Ji-Hyun Lee1, Pyoyoon Kang1, In Sun Song1

  • 1Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

British Journal of Anaesthesia
|October 23, 2021
PubMed

Insights

The optimal mechanical ventilation strategy for young children undergoing anesthesia involves a tidal volume (VT) of 5 ml/kg with 10 cm H2O positive end-expiratory pressure (PEEP). This combination appears to improve lung compliance and minimize airway pressures in children under 6 years old.

Area of Science:

  • Anesthesiology
  • Pediatric Critical Care
  • Respiratory Physiology

Background:

  • Optimal intraoperative ventilation strategies for pediatric patients are not well-established.
  • Limited data exist on the best combination of positive end-expiratory pressure (PEEP) and tidal volume (VT) for children.

Purpose of the Study:

  • To determine the optimal PEEP and VT settings for mechanically ventilated children younger than 6 years.
  • To assess these settings based on intratidal compliance profiles and secondary airway pressure measurements.

Main Methods:

  • Infants, toddlers, and children (1 month to 6 years) were assigned to four ventilation settings: PEEP 8/VT 8, PEEP 10/VT 5, PEEP 10/VT 8, and PEEP 12/VT 5.
  • Intratidal compliance profiles (horizontal, increasing, decreasing) and airway pressures (peak inspiratory, plateau, driving) were primary and secondary outcomes, respectively.

Main Results:

  • A horizontal compliance profile, indicating optimal ventilation, was most frequent with PEEP 10 cm H2O/VT 5 ml kg-1 (60.5%).
  • Lower plateau airway pressures and the lowest driving pressure were observed with PEEP 10/VT 5.
  • Decreasing compliance profiles were associated with higher PEEP or VT settings.

Conclusions:

  • A VT of 5 ml kg-1 combined with 10 cm H2O PEEP may be the optimal setting to reduce atelectasis and overdistension in mechanically ventilated children under 6 years.
  • Further research is needed to evaluate the impact of these settings on postoperative pulmonary complications.
Abstract

Keywords:
PEEPgeneral anaesthesialung compliancepaediatricstidal volumes

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