title: Intratidal recruitment/derecruitment persists at low and moderate positive end-expiratory pressure in paediatric patients.
abstract: In paediatric patients positive end-expiratory pressure (PEEP) is traditionally set lower than in adults. We investigated whether moderately higher PEEP improves respiratory mechanics and regional ventilation. Therefore, 40 children were mechanically ventilated with PEEP 2 and 5cmH2O. Volume-dependent compliance profiles were analysed as a measure of intratidal recruitment/derecruitment. Regional ventilation was assessed using electrical impedance tomography. Mean compliance was 17.9±9.9mLcmH2O-1(PEEP 2cmH2O), and 19.0±10.9mLcmH2O-1(PEEP 5 cmH2O, p<0.001). Strong intratidal recruitment/derecruitment occurred in 40% of children at PEEP 2 cmH2O, and 36% at PEEP 5 cmH2O. Children showing strong recruitment/derecruitment were 33 (PEEP 2 cmH20) and 20 (PEEP 5 cmH20) months younger than children showing moderate recruitment/derecruitment. A higher PEEP improved peripheral ventilation. In conclusion, mechanically ventilated paediatric patients undergo intratidal recruitment/derecruitment which occurs more prominently in younger than in older children. A PEEP of 5cmH2O does not fully prevent intratidal recruitment/derecruitment but homogenizes regional ventilation in comparison to 2cmH2O.
authors: Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany. Electronic address: steffen.wirth@uniklinik-freiburg.de.
authors: Steffen
authors: S
authors: Wirth
authors: Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany.
authors: Lisa
authors: L
authors: Artner
authors: Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany.
authors: Tobias
authors: T
authors: Broß
authors: Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany.
authors: Sara
authors: S
authors: Lozano-Zahonero
authors: Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany.
authors: Johannes
authors: J
authors: Spaeth
authors: Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany.
authors: Stefan
authors: S
authors: Schumann
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D000768:Anesthesia, General / Q000379:methods; D002648:Child; D002675:Child, Preschool; D017097:Electric Impedance; D005260:Female; D006801:Humans; D007223:Infant; D008170:Lung Compliance / Q000502:physiology; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D008176:Lung Volume Measurements; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D012119:Respiration; D015656:Respiratory Mechanics / Q000502:physiology*; D013990:Tidal Volume / Q000502:physiology*; D014054:Tomography
keywords: Children; Compliance–volume curve; Functional residual capacity; Lung compliance; Mechanical ventilation; Protective ventilation; Respiratory system mechanics