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A Comparative Study of Two Inspiratory Pressure Levels for Pressure-Controlled Face-Mask Ventilation in Children
Sateesh Verma1, Tripti Singh1, Rajesh Raman1
1Anesthesiology and Critical Care, King George's Medical University, Lucknow, IND.
Cureus
|July 21, 2025
Summary
Lower inspiratory pressure (12 cm H₂O) during face mask ventilation in children is more effective at preventing gastric insufflation than higher pressure (16 cm H₂O). This finding helps optimize anesthesia induction safety.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Medical Devices
Background:
- Inappropriate inspiratory pressure during anesthesia induction via face mask can lead to gastric insufflation.
- Optimizing pressure settings is crucial for patient safety during mechanical ventilation.
- Ultrasonography offers a non-invasive method to assess gastric volume changes.
Purpose of the Study:
- To compare the effectiveness of 12 cm H₂O versus 16 cm H₂O inspiratory pressure during pressure-controlled face mask ventilation.
- To determine the impact of these pressures on gastric insufflation in pediatric patients.
- Primary objective: Measure and compare the cross-sectional area (CSA) of the gastric antrum using ultrasonography.
Main Methods:
- A comparative randomized trial involving 40 children under five years old undergoing general anesthesia.
- Participants received face mask ventilation for four minutes at either 12 cm H₂O (Group P12) or 16 cm H₂O (Group P16) inspiratory pressure.
- Gastric antrum CSA was measured via ultrasonography before and after ventilation; respiratory and hemodynamic parameters were also recorded.
Main Results:
- Both groups showed an increase in gastric antrum CSA post-ventilation.
- Group P16 demonstrated a significantly greater increase in antrum CSA (1.09 to 1.53 cm², p=0.001) compared to Group P12 (1.13 to 1.24 cm², p=0.214).
- The intergroup difference in antral CSA post-ventilation was significant (p=0.035); Group P16 also delivered excessive tidal volumes (9-10 ml/kg).
Conclusions:
- An inspiratory pressure of 16 cm H₂O during face mask ventilation leads to greater gastric antrum distension in children compared to 12 cm H₂O.
- The 12 cm H₂O pressure setting is sufficient for adequate ventilation while minimizing gastric insufflation.
- Lower inspiratory pressure (12 cm H₂O) is recommended for pressure-controlled face mask ventilation in pediatric anesthesia induction.
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