Determination of optimal positive end‐expiratory pressure using electrical impedance tomography in infants under general anesthesia: Comparison between supine and prone positions
Ji‐Hyun Lee, Pyoyoon Kang, Jung‐Bin Park, Sang‐Hwan Ji, Young‐Eun Jang, Eun‐Hee Kim, Jin‐Tae Kim, Hee‐Soo Kim
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引用次数: 0
Abstract
AimsThis study determined the optimal positive end‐expiratory pressure levels in infants in supine and prone positions under general anesthesia using electrical impedance tomography (EIT).MethodsThis prospective observational single‐centre study included infants scheduled for surgery in the prone position. An electrical impedance tomography sensor was applied after inducing general anesthesia. The optimal positive end‐expiratory pressure in the supine position was determined in a decremental trial based on EIT and compliance. Subsequently, the patient's position was changed to prone. Electrical impedance tomography parameters, including global inhomogeneity index, regional ventilation delay, opening pressure, the centre of ventilation, and pendelluft volume, were continuously obtained up to 1 h after prone positioning. The optimal positive end‐expiratory pressure in the prone position was similarly determined.ResultsData from 30 infants were analyzed. The mean value of electrical impedance tomography‐based optimal positive end‐expiratory pressure in the prone position was significantly higher than that in the supine position [10.9 (1.6) cmH2O and 6.1 (0.9) cmH2O, respectively (p < .001)]. Significant differences were observed between electrical impedance tomography‐ and compliance‐based optimal positive end‐expiratory pressure. Peak and mean airway, plateau, and driving pressures increased 1 h after prone positioning compared with those in the supine position. In addition, the centre of ventilation for balance in ventilation between the ventral and dorsal regions improved.ConclusionThe prone position required higher positive end‐expiratory pressure than the supine position in mechanically ventilated infants under general anesthesia. EIT is a promising tool to find the optimal positive end‐expiratory pressure, which needs to be individualized.
期刊介绍:
Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.