Division of Anesthesiology and Unit for Anesthesiological Investigations, Department of Acute Medicine, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland.
Pediatric Anesthesia Unit, Department of Acute Medicine, University Hospitals of Geneva, Geneva, Switzerland.
Paediatr Anaesth. 2022 Feb;32(2):286-294. doi: 10.1111/pan.14344. Epub 2021 Dec 5.
Extraordinary progress has been made during the past few decades in the development of anesthesia machines and ventilation techniques. With unprecedented precision and performance, modern machines for pediatric anesthesia can deliver appropriate mechanical ventilation for children and infants of all sizes and with ongoing respiratory diseases, ensuring very small volume delivery and compensating for circuit compliance. Along with highly accurate monitoring of the delivered ventilation, modern ventilators for pediatric anesthesia also have a broad choice of ventilation modalities, including synchronized and assisted ventilation modes, which were initially conceived for ventilation weaning in the intensive care setting. Despite these technical advances, there is still room for improvement in pediatric mechanical ventilation. There is a growing effort to minimize the harm of intraoperative mechanical ventilation of children by adopting the protective ventilation strategies that were previously employed only for prolonged mechanical ventilation. More than ever, the pediatric anesthesiologist should now recognize that positive-pressure ventilation is potentially a harmful procedure, even in healthy children, as it can contribute to both ventilator-induced lung injury and ventilator-induced diaphragmatic dysfunction. Therefore, careful choice of the ventilation modality and its parameters is of paramount importance to optimize gas exchange and to protect the lungs from injury during general anesthesia. The present report reviews the novel ventilation techniques used for children, discussing the advantages and pitfalls of the ventilation modalities available in modern anesthesia machines, as well as innovative ventilation modes currently under development or research. Several innovative strategies and devices are discussed. These novel modalities are likely to become part of the armamentarium of the pediatric anesthesiologist in the near future and are particularly relevant for challenging ventilation scenarios.
在过去的几十年中，麻醉机和通气技术的发展取得了非凡的进步。现代儿科麻醉机具有前所未有的精确性和性能，可以为所有大小和患有持续呼吸系统疾病的儿童提供适当的机械通气，确保小容量输送，并补偿回路顺应性。随着对输送通气的高度精确监测，现代儿科麻醉通气机还具有广泛的通气模式选择，包括同步和辅助通气模式，这些模式最初是为重症监护环境中的通气撤机而设想的。尽管取得了这些技术进步，但儿童机械通气仍有改进的空间。人们越来越努力通过采用以前仅用于长时间机械通气的保护性通气策略来减轻儿童术中机械通气的危害。儿科麻醉师现在应该比以往任何时候都更加认识到，正压通气即使在健康儿童中也是一种潜在的有害程序，因为它可能导致呼吸机引起的肺损伤和呼吸机引起的膈肌功能障碍。因此，仔细选择通气模式及其参数对于优化气体交换和在全身麻醉期间保护肺部免受损伤至关重要。本报告回顾了用于儿童的新型通气技术，讨论了现代麻醉机中可用的通气模式的优点和缺点，以及目前正在开发或研究的创新通气模式。讨论了几种创新策略和设备。这些新型模式很可能在不久的将来成为儿科麻醉师的武器库的一部分，并且对于具有挑战性的通气情况尤其相关。
