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Ventilation distribution in mechanically ventilated children in response to positioning: An exploratory study

A Lupton-Smith1,2, A Argent2, B Morrow2

  • 1Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.

The Southern African Journal of Critical Care : the Official Journal of the Critical Care Society
|August 28, 2025
PubMed

Insights

Ventilation distribution in mechanically ventilated children is variable and not unlike healthy children. Body positioning should be individualized for each child to optimize breathing. This study offers new insights into pediatric ventilation patterns.

Area of Science:

  • Pediatric critical care medicine
  • Respiratory physiology
  • Medical imaging techniques

Background:

  • Traditional understanding suggests universal non-dependent lung ventilation in children.
  • Recent studies challenge established ventilation distribution patterns in pediatric populations.
  • No prior studies have investigated the impact of body position on mechanically ventilated infants and children.

Purpose of the Study:

  • To investigate the influence of different body positions on regional ventilation distribution in mechanically ventilated children.
  • To provide data on ventilation patterns in pediatric patients requiring mechanical ventilation.

Main Methods:

  • Utilized Thoracic Electrical Impedance Tomography (EIT) to assess regional ventilation.
  • Measurements were taken in supine, prone, left-side lying, and right-side lying positions.
  • Calculated regional ventilation parameters including relative tidal impedance (ΔZ) and proportion of ventilation in different lung regions.

Main Results:

  • Seventeen children (6 months to 6 years) were studied.
  • A significant proportion of children showed greater ventilation in the right lung (side-lying) and dorsal lung regions (supine/prone).
  • Regional lung filling remained consistent across different body positions.

Conclusions:

  • Ventilation distribution in mechanically ventilated children with mild lung disease is variable.
  • Patterns observed are similar to healthy, spontaneously breathing infants and children.
  • Individualized positioning strategies are recommended to optimize ventilation in pediatric patients.
Abstract

Keywords:
Paediatric critical carebody positioningelectrical impedance tomographyinfants/childrenmechanical ventilationventilation distribution

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