Pressure support ventilation improves ventilation during inhalational induction of anesthesia in children: A pilot study

IF 5 2区医学 Q1 ANESTHESIOLOGY Journal of Clinical Anesthesia Pub Date : 2025-02-01 DOI:10.1016/j.jclinane.2024.111710

Viviane Lauret MD , Claude Guerin MD-PhD , Sirine Boussena MD , Mathilde De-Queiroz MD , Lionel Bouvet MD-PhD , Florent Baudin MD-PhD

{"title":"Pressure support ventilation improves ventilation during inhalational induction of anesthesia in children: A pilot study","authors":"Viviane Lauret MD , Claude Guerin MD-PhD , Sirine Boussena MD , Mathilde De-Queiroz MD , Lionel Bouvet MD-PhD , Florent Baudin MD-PhD","doi":"10.1016/j.jclinane.2024.111710","DOIUrl":null,"url":null,"abstract":"<div><h3>Study objective</h3><div>To evaluate the impact of positive end-expiratory pressure (PEEP) with or without pressure support ventilation (PSV) on the lung volume and the ventilation distribution during inhalational induction of anesthesia in children.</div></div><div><h3>Design</h3><div>Prospective observational clinical pilot-study.</div></div><div><h3>Setting</h3><div>University Children's Hospital of Lyon, France.</div></div><div><h3>Patients</h3><div>Children without significant comorbidity (ASA 1 or 2) undergoing planned or unplanned surgery with inhalational induction of anesthesia.</div></div><div><h3>Intervention</h3><div>After the beginning of Guedel's stage 3 of anesthesia, several settings were applied for 60 s in the following systematic order: spontaneous breathing when applying a facemask (SB-Mask), then PEEP 4 cmH<sub>2</sub>O, PSV 4 cmH2O above PEEP 4 cmH<sub>2</sub>O, and PSV 4 to 7 cmH<sub>2</sub>O above PEEP 4 cmH<sub>2</sub>O, at the anesthesiologist's discretion.</div></div><div><h3>Measurements</h3><div>Children were monitored using Electrical Impedance Tomography (EIT; Pulmovista 500, Dräger, France). Tidal volume (TV), dorsal fraction of the ventilation, and end-expiratory lung impedance (EELI) were assessed with the ventilator and EIT.</div></div><div><h3>Main results</h3><div>Twenty-two patients were included (20 analyzed), their median [IQR] age was 21 [14–36] months. TV did not significantly differ between the settings. The increase in EELI was greater with PSV (+0.60 [0.48–0.91] arbitrary units) than with PEEP 4 cmH<sub>2</sub>O alone (+0.39 [0.20–0.06] arbitrary units, <em>p</em> = 0.005), and did not change with increased level of PSV (+0.66 [0.40–1.22] arbitrary units). The dorsal fraction of lung ventilation decreased using PSV, from 56 % [45–63] with SB-mask to 53 % [43–56] with PSV 4cmH<sub>2</sub>O (<em>p</em> = 0.002) and 47 % [40–55] with PSV 7cmH<sub>2</sub>O (<em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>The ventilator settings used during inhalational induction of anesthesia in children have an impact on lung ventilation. PSV during inhalational induction of anesthesia in children may restore the end-expiratory lung volume independently from the increase in TV.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111710"},"PeriodicalIF":5.0000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0952818024003404","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Study objective

To evaluate the impact of positive end-expiratory pressure (PEEP) with or without pressure support ventilation (PSV) on the lung volume and the ventilation distribution during inhalational induction of anesthesia in children.

Design

Prospective observational clinical pilot-study.

Setting

University Children's Hospital of Lyon, France.

Patients

Children without significant comorbidity (ASA 1 or 2) undergoing planned or unplanned surgery with inhalational induction of anesthesia.

Intervention

After the beginning of Guedel's stage 3 of anesthesia, several settings were applied for 60 s in the following systematic order: spontaneous breathing when applying a facemask (SB-Mask), then PEEP 4 cmH₂O, PSV 4 cmH2O above PEEP 4 cmH₂O, and PSV 4 to 7 cmH₂O above PEEP 4 cmH₂O, at the anesthesiologist's discretion.

Measurements

Children were monitored using Electrical Impedance Tomography (EIT; Pulmovista 500, Dräger, France). Tidal volume (TV), dorsal fraction of the ventilation, and end-expiratory lung impedance (EELI) were assessed with the ventilator and EIT.

Main results

Twenty-two patients were included (20 analyzed), their median [IQR] age was 21 [14–36] months. TV did not significantly differ between the settings. The increase in EELI was greater with PSV (+0.60 [0.48–0.91] arbitrary units) than with PEEP 4 cmH₂O alone (+0.39 [0.20–0.06] arbitrary units, p = 0.005), and did not change with increased level of PSV (+0.66 [0.40–1.22] arbitrary units). The dorsal fraction of lung ventilation decreased using PSV, from 56 % [45–63] with SB-mask to 53 % [43–56] with PSV 4cmH₂O (p = 0.002) and 47 % [40–55] with PSV 7cmH₂O (p = 0.001).

Conclusion

The ventilator settings used during inhalational induction of anesthesia in children have an impact on lung ventilation. PSV during inhalational induction of anesthesia in children may restore the end-expiratory lung volume independently from the increase in TV.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

压力支持通气改善儿童吸入诱导麻醉时的通气：一项初步研究。

研究目的：探讨有或无压力支持通气（PSV）时呼气末正压（PEEP）对儿童吸入诱导麻醉时肺容量及通气分布的影响。设计：前瞻性观察性临床试验。地点：法国里昂大学儿童医院。患者：无明显合并症（ASA 1或2）的儿童，接受计划内或计划外的吸入诱导麻醉手术。干预：Guedel第3阶段麻醉开始后，按以下系统顺序进行几种设置，持续60秒：在使用面罩（sdb - mask）时进行自发呼吸，然后是PEEP 4 cmH2O， PSV 4 cmH2O高于PEEP 4 cmH2O， PSV 4至7 cmH2O高于PEEP 4 cmH2O，由麻醉师自行决定。测量方法：使用电阻抗断层扫描（EIT）监测儿童；Pulmovista 500, Dräger，法国)。使用呼吸机和EIT评估潮气量（TV）、通气背侧分数和呼气末肺阻抗（EELI）。主要结果：纳入22例患者（分析20例），中位[IQR]年龄21[14-36]个月。电视在设置之间没有显著差异。PSV组EELI升高（+0.60[0.48-0.91]任意单位）大于单独使用PEEP 4 cmH2O组（+0.39[0.20-0.06]任意单位，p = 0.005），且不随PSV水平升高而变化（+0.66[0.40-1.22]任意单位）。使用PSV时，肺通气的背侧比例下降，从使用SB-mask时的56%[45-63]下降到使用PSV 4cmH2O时的53% [43-56]（p = 0.002）和使用PSV 7cmH2O时的47% [40-55]（p = 0.001）。结论：儿童吸入诱导麻醉时使用的呼吸机设置对肺通气有影响。儿童吸入诱导麻醉时的PSV可能独立于TV的增加而恢复呼气末肺容量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.