{"title":"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。","authors":"Viviane Lauret, Claude Guerin, Sirine Boussena, Mathilde De-Queiroz, Lionel Bouvet, Florent Baudin","doi":"10.1016/j.jclinane.2024.111710","DOIUrl":null,"url":null,"abstract":"<p><strong>Study objective: </strong>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.</p><p><strong>Design: </strong>Prospective observational clinical pilot-study.</p><p><strong>Setting: </strong>University Children's Hospital of Lyon, France.</p><p><strong>Patients: </strong>Children without significant comorbidity (ASA 1 or 2) undergoing planned or unplanned surgery with inhalational induction of anesthesia.</p><p><strong>Intervention: </strong>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.</p><p><strong>Measurements: </strong>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.</p><p><strong>Main results: </strong>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, 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 4cmH<sub>2</sub>O (p = 0.002) and 47 % [40-55] with PSV 7cmH<sub>2</sub>O (p = 0.001).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"111710"},"PeriodicalIF":5.0000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Pressure support ventilation improves ventilation during inhalational induction of anesthesia in children: A pilot study.\",\"authors\":\"Viviane Lauret, Claude Guerin, Sirine Boussena, Mathilde De-Queiroz, Lionel Bouvet, Florent Baudin\",\"doi\":\"10.1016/j.jclinane.2024.111710\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study objective: </strong>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.</p><p><strong>Design: </strong>Prospective observational clinical pilot-study.</p><p><strong>Setting: </strong>University Children's Hospital of Lyon, France.</p><p><strong>Patients: </strong>Children without significant comorbidity (ASA 1 or 2) undergoing planned or unplanned surgery with inhalational induction of anesthesia.</p><p><strong>Intervention: </strong>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.</p><p><strong>Measurements: </strong>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.</p><p><strong>Main results: </strong>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, 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 4cmH<sub>2</sub>O (p = 0.002) and 47 % [40-55] with PSV 7cmH<sub>2</sub>O (p = 0.001).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":15506,\"journal\":{\"name\":\"Journal of Clinical Anesthesia\",\"volume\":\"101 \",\"pages\":\"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://doi.org/10.1016/j.jclinane.2024.111710\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/17 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jclinane.2024.111710","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/17 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Pressure support ventilation improves ventilation during inhalational induction of anesthesia in children: A pilot study.
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.
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.
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.
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