From the Department of Anesthesiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Anesth Analg. 2015 Jan;120(1):165-175. doi: 10.1213/ANE.0000000000000472.
Mechanical ventilation of the pediatric patient is challenging because small changes in delivered volume can be a significant fraction of the intended tidal volume. Anesthesia ventilators have traditionally been poorly suited to delivering small tidal volumes accurately, and pressure-controlled ventilation has become used commonly when caring for pediatric patients. Modern anesthesia ventilators are designed to deliver small volumes accurately to the patient's airway by compensating for the compliance of the breathing system and delivering tidal volume independent of fresh gas flow. These technology advances provide the opportunity to implement a lung-protective ventilation strategy in the operating room based upon control of tidal volume. This review will describe the capabilities of the modern anesthesia ventilator and the current understanding of lung-protective ventilation. An optimal approach to mechanical ventilation for the pediatric patient is described, emphasizing the importance of using bedside monitors to optimize the ventilation strategy for the individual patient.
小儿患者的机械通气具有挑战性，因为输送的体积的微小变化可能是预期潮气量的一个显著部分。传统上，麻醉呼吸机不太适合准确输送小潮气量，并且当护理小儿患者时，压力控制通气已变得常用。现代麻醉呼吸机旨在通过补偿呼吸回路的顺应性并独立于新鲜气流输送潮气量来准确地向患者气道输送小体积。这些技术进步为在手术室中基于潮气量控制实施肺保护性通气策略提供了机会。本综述将描述现代麻醉呼吸机的功能和目前对肺保护性通气的理解。描述了小儿患者机械通气的最佳方法，强调使用床边监测器优化个体患者的通气策略的重要性。
