Derivation and validation of an equation to determine the optimal ventilator setting in children undergoing intracranial revascularization surgery: A single-center retrospective study.
Adolescent
Anesthesia, General
/ standards
Body Weight
Carbon Dioxide
Child
Child, Preschool
Female
Humans
Hypercapnia
/ prevention & control
Hypocapnia
/ prevention & control
Infant
Infant, Newborn
Male
Mathematical Concepts
Monitoring, Physiologic
Moyamoya Disease
/ surgery
Pulmonary Ventilation
Respiratory Rate
/ physiology
Retrospective Studies
Tidal Volume
Ventilators, Mechanical
child
hypercapnia
hypocapnia
infant
moyamoya disease
ventilators
Journal
Paediatric anaesthesia
ISSN: 1460-9592
Titre abrégé: Paediatr Anaesth
Pays: France
ID NLM: 9206575
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
31
05
2019
revised:
15
09
2019
accepted:
04
11
2019
pubmed:
17
11
2019
medline:
3
2
2021
entrez:
17
11
2019
Statut:
ppublish
Résumé
It can be difficult to determine the appropriate ventilator settings to maintain normocapnia in children undergoing general anesthesia for surgery for moyamoya disease, especially immediately following anesthesia induction. We conducted this study to attempt to derive an equation to predict the appropriate ventilator settings and subsequently validated the accuracy of the equation. A retrospective study of 91 pediatric patients less than 18 years of age who underwent cerebral revascularization for moyamoya disease at our institution. Fifty-eight patients were used to derive the equation, and the subsequent 33 patients were used to validate the equation. We calculated the required respiratory rate to attain normocapnia based on the median of all values of the minute volume during normocapnia (estimated partial pressure of arterial carbon dioxide of 38-42 mm Hg) and the assumption that the tidal volume was 8 mL/kg body weight. We derived the regression equation from the derivation data set where the required respiratory rate to attain normocapnia was represented by age. We simplified the equation by rounding coefficients to the nearest integer. The level of agreement between the respiratory rate predicted from the equation and the actual required respiratory rate was assessed in the validation group using Bland-Altman analysis. The derived equation is tidal volume = 8 mL/kg body weight, respiratory rate = 24-age/min. Bland-Altman analysis in the validation group revealed that the mean bias between the predicted and actual respiratory rate was 0.29 (standard deviation, 3.67). The percentage of cases where the predicted rate was within ± 10% and ± 20% of the actual rate was 42.4% and 66.7%, respectively. We derived and validated a simple and easily applicable equation to predict the ventilator settings required to attain normocapnia during general anesthesia in children with moyamoya disease.
Sections du résumé
BACKGROUND
It can be difficult to determine the appropriate ventilator settings to maintain normocapnia in children undergoing general anesthesia for surgery for moyamoya disease, especially immediately following anesthesia induction.
AIM
We conducted this study to attempt to derive an equation to predict the appropriate ventilator settings and subsequently validated the accuracy of the equation.
METHODS
A retrospective study of 91 pediatric patients less than 18 years of age who underwent cerebral revascularization for moyamoya disease at our institution. Fifty-eight patients were used to derive the equation, and the subsequent 33 patients were used to validate the equation. We calculated the required respiratory rate to attain normocapnia based on the median of all values of the minute volume during normocapnia (estimated partial pressure of arterial carbon dioxide of 38-42 mm Hg) and the assumption that the tidal volume was 8 mL/kg body weight. We derived the regression equation from the derivation data set where the required respiratory rate to attain normocapnia was represented by age. We simplified the equation by rounding coefficients to the nearest integer. The level of agreement between the respiratory rate predicted from the equation and the actual required respiratory rate was assessed in the validation group using Bland-Altman analysis.
RESULTS
The derived equation is tidal volume = 8 mL/kg body weight, respiratory rate = 24-age/min. Bland-Altman analysis in the validation group revealed that the mean bias between the predicted and actual respiratory rate was 0.29 (standard deviation, 3.67). The percentage of cases where the predicted rate was within ± 10% and ± 20% of the actual rate was 42.4% and 66.7%, respectively.
CONCLUSIONS
We derived and validated a simple and easily applicable equation to predict the ventilator settings required to attain normocapnia during general anesthesia in children with moyamoya disease.
Substances chimiques
Carbon Dioxide
142M471B3J
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
50-56Informations de copyright
© 2019 John Wiley & Sons Ltd.
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