Intratracheal pulmonary ventilation improves gas exchange during laparoscopy in a pediatric lung injury model.
OBJECTIVE
This study was aimed at determining whether intraoperative intratracheal pulmonary ventilation (ITPV) could prevent/treat respiratory complications of laparoscopy in a model of pediatric pulmonary insufficiency.


METHODS
Severe lung injury was induced in 0- to 2-month-old lambs (n = 5) by endotracheal saline lavage. Animals then underwent establishment of CO2 pneumoperitoneum. Intraperitoneal pressures were progressively raised from 0 to 15 mm Hg, at intervals of 5 mm Hg. At each interval, blood gas and hemodynamic data were recorded, 20 minutes after initiation of both conventional ventilation and pure ITPV. All ventilatory parameters were constant and identical on both modes of ventilation.


RESULTS
On conventional ventilation, severe respiratory acidosis and hypoxemia ensued at intraperitoneal pressures of 5 mm Hg and 10 mm Hg or more, respectively. Compared with conventional ventilation, ITPV led to statistically significant decreases in PCO2 at intraperitoneal pressures of 5 mm Hg (43.2 +/- 5.2 vs 56.1 +/- 6.6 mm Hg) and 10 mm Hg (45.1 +/- 3.2 vs 61 +/- 6.3 mm Hg) and to significant increases in PO2 at 10 mm Hg (92 +/- 10.2 vs 61 +/- 8.1 mm Hg), resolving the acidosis and hypoxemia at those pressure levels.


CONCLUSIONS
Compared with conventional ventilation, ITPV improves both CO2 removal and oxygenation during CO2 pneumoperitoneum in a pediatric lung injury model. Intratracheal pulmonary ventilation may be a safer intraoperative mode of ventilation for neonates and children with respiratory failure who require laparoscopy.
Fuchs
Julie R
JR
Department of Surgery, Children's Hospital Boston, Boston, MA 02115, USA.
Kaviani
Amir
A
Watson
Kenneth
K
Thompson
John
J
Wilson
Jay M
JM
Fauza
Dario O
DO
D000142:Acidosis, Respiratory / Q000209:etiology; D000280:Administration, Inhalation; D000818:Animals; D002245:Carbon Dioxide / Q000627:therapeutic use; D004195:Disease Models, Animal; D005740:Gases / Q000627:therapeutic use; D007432:Intraoperative Period; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D009676:Noxae / Q000008:administration & dosage; D011027:Pneumoperitoneum / Q000150:complications*; D011312:Pressure / Q000009:adverse effects; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000139:chemically induced; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D012756:Sheep; D012965:Sodium Chloride / Q000008:administration & dosage
D005740:Gases; D009676:Noxae; D002245:Carbon Dioxide; D012965:Sodium Chloride