Alveolar target ventilation and dead space in children under anaesthesia: The proventiped cohort study.
Journal
European journal of anaesthesiology
ISSN: 1365-2346
Titre abrégé: Eur J Anaesthesiol
Pays: England
ID NLM: 8411711
Informations de publication
Date de publication:
01 07 2023
01 07 2023
Historique:
medline:
8
6
2023
pubmed:
14
4
2023
entrez:
13
4
2023
Statut:
ppublish
Résumé
Ventilator settings in children under anaesthesia remain difficult because of the changes in the physiology and the high dead space. To determine the alveolar minute-volume to sustain normocapnia in children under mechanical ventilation. A prospective observational study. This study was performed between May and October 2019 in a tertiary care children's hospital. Children between 2 months and 12 years, weighing between 5 and 40 kg, admitted for general anaesthesia. Volumetric capnography was used to estimate the alveolar and dead space volume (Vd). Total and alveolar minute ventilation in (ml kg -1 min -1 ) over 100 breaths. Sixty patients were included comprising 20 per group: 5 to 10 kg (group 1), 10 to 20 kg (group 2), 20 to 40 kg (group 3). Seven patients were excluded for aberrant capnographic curves. After normalisation to weight, the median [IQR] tidal volume per kilogram was similar between the three groups: 6.5 ml kg -1 [6.0 to 7.5 ml kg -1 ], 6.4 ml kg -1 [5.7 to 7.3 ml kg -1 ], 6.4 ml kg -1 [5.3 to 6.8 ml kg -1 ]; P = 0.3. Total Vd (in ml kg -1 ) was negatively correlated to weight ( r = -0.62, 95% confidence interval -0.41 to -0.76, P < 0.001). The total normalised minute ventilation (ml kg -1 min -1 ) to obtain normocapnia was higher in group 1 than in group 2 and in group 3; 203 ml kg -1 min -1 [175 to 219 ml kg -1 min -1 ], 150 ml kg -1 min -1 [139 to 181 ml kg -1 min -1 ] and 128 ml kg -1 min -1 [107 to 157 ml kg -1 min -1 ]; P < 0.001 (mean ± SD), but (mean ± SD) alveolar minute ventilation was similar between the three groups; 68 ± 21 ml kg -1 min -1 . Total dead space volume (including apparatus dead space) represents a major component of tidal volume in children less than 30 kg, when using large heat and moisture exchanger filters. The total minute ventilation necessary to achieve normocapnia decreased with increasing weight, while the alveolar minute ventilation remained constant. ClinicalTrials.gov, identifier: NCT03901599.
Identifiants
pubmed: 37052073
doi: 10.1097/EJA.0000000000001832
pii: 00003643-202307000-00007
doi:
Substances chimiques
Carbon Dioxide
142M471B3J
Banques de données
ClinicalTrials.gov
['NCT03901599']
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
495-500Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2023 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.
Références
Numa AH, Newth CJ. Anatomic dead space in infants and children. J Appl Physiol 1996; 80:1485–1489.
Pearsall MF, Feldman JM. When does apparatus dead space matter for the pediatric patient? Anesth Analg 2014; 118:1404–1408.
King MR, Feldman JM. Optimal management of apparatus dead space in the anesthetized infant. Pediatr Anesth 2017; 27:1185–1192.
Feldman JM. Optimal ventilation of the anesthetized pediatric patient. Anesth Analg 2015; 120:165–175.
Kneyber MCJ. Intraoperative mechanical ventilation for the pediatric patient. Best Pract Res Clin Anaesthesiol 2015; 29:371–379.
Young CC, Harris EM, Vacchiano C, et al. Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations. Brit J Anaesth 2019; 123:898–913.
Brück K. Heat production and temperature regulation. Perinatal physiology. Springer; Boston, MA, USA. pp. 455–98.
Lewis RC, Duval AM. Standards for the basal metabolism of children from 2 to 15 years of age, inclusive. J Pediatrics 1943; 23:1–18.
Kornecki A, Tsuchida S, Ondiveeran HK, et al. Lung development and susceptibility to ventilator-induced lung injury. Am J Resp Crit Care 2005; 171:743–752.
Kneyber MCJ, Zhang H, Slutsky AS. Ventilator-induced lung injury. Similarity and differences between children and adults. Am J Resp Crit Care 2014; 190:258–265.
Fowler WS. Lung function studies. II. The respiratory dead space. Am J Physiol 1948; 154:405–416.
Suarez-Sipmann F, Bohm SH, Tusman G. Volumetric capnography: the time has come. Curr Opin Crit Care 2014; 20:333–339.
Bhalla AK, Rubin S, Newth CJL, et al. Monitoring dead space in mechanically ventilated children: volumetric capnography versus time-based capnography. Respir Care 2015; 60:1548–1555.
Bourgoin P, Baudin F, Brossier D, et al. Assessment of Bohr and Enghoff dead space equations in mechanically ventilated children. Respir Care 2017; 62:468–474.
Fletcher R, Jonson B, Cummin G, Brew J. The concept of deadspace with special reference to the single breath test for carbon dioxide. Bja Br J Anaesth 1981; 53:77–88.
Baudin F, Bourgoin P, Brossier D, et al. Noninvasive estimation of arterial CO2 from end-tidal CO2 in mechanically ventilated children. Pediatr Crit Care Me 2016; 17:1117–1123.
Lebossé M, Kern D, Queiroz MD, et al. Ventilation in pediatric anesthesia: a French multicenter prospective observational study (PEDIAVENT). Pediatr Anesth 2020; 30:912–921.
Chau A, Kobe J, Kalyanaraman R, et al. Beware the airway filter: deadspace effect in children under 2 years. Pediatr Anesth 2006; 16:932–938.
Hinkson CR, Benson MS, Stephens LM, Deem S. The effects of apparatus dead space on P(aCO2) in patients receiving lung-protective ventilation. Respir Care 2006; 51:1140–1144.
McSwain SD, Hamel DS, Smith PB, et al. End-tidal and arterial carbon dioxide measurements correlate across all levels of physiologic dead space. Respir Care 2010; 55:288–293.
Sanders JC, Gerstein N. Arterial to endtidal carbon dioxide gradient during pediatric laparoscopic fundoplication. Pediatr Anesth 2008; 18:1096–1101.
Duyu M, Çağlar YM, Karakaya Z, et al. Comparison of arterial CO2 estimation by end-tidal and transcutaneous CO2 measurements in intubated children and variability with subject related factors. J Clin Monitor Comp 2021; 35:101–111.