Lauret Viviane, Guerin Claude, Boussena Sirine, De-Queiroz Mathilde, Bouvet Lionel, Baudin Florent
Hospices Civils de Lyon, Département d'anesthésie, Hôpital Femme Mère Enfant, F - 69500 Bron, France.
Hospices Civils de Lyon, Médecine intensive réanimation, Hôpital Edouard Herriot, F - 69500 Bron, France; Université de Lyon, Faculté de Médecine Lyon-Est, Lyon, France.
J Clin Anesth. 2025 Feb;101:111710. doi: 10.1016/j.jclinane.2024.111710. Epub 2024 Dec 17.
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.
Prospective observational clinical pilot-study.
University Children's Hospital of Lyon, France.
Children without significant comorbidity (ASA 1 or 2) undergoing planned or unplanned surgery with inhalational induction of anesthesia.
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 cmHO, PSV 4 cmH2O above PEEP 4 cmHO, and PSV 4 to 7 cmHO above PEEP 4 cmHO, at the anesthesiologist's discretion.
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.
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 cmHO 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 4cmHO (p = 0.002) and 47 % [40-55] with PSV 7cmHO (p = 0.001).
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.
评估呼气末正压通气（PEEP）联合或不联合压力支持通气（PSV）对儿童吸入麻醉诱导期肺容量和通气分布的影响。
前瞻性观察性临床试点研究。
法国里昂大学儿童医院。
计划内或计划外手术且采用吸入麻醉诱导的无明显合并症（美国麻醉医师协会分级1或2级）儿童。
在麻醉进入古德（Guedel）三期后，按以下系统顺序依次设置60秒：面罩通气时自主呼吸（SB - 面罩），然后是4 cmH₂O的PEEP，高于4 cmH₂O PEEP 4 cmH₂O的PSV，以及高于4 cmH₂O PEEP 4至7 cmH₂O的PSV，由麻醉医生酌情决定。
使用电阻抗断层扫描（EIT；法国德尔格公司的Pulmovista 500）对儿童进行监测。通过呼吸机和EIT评估潮气量（TV）、通气的背侧部分以及呼气末肺阻抗（EELI）。
纳入22例患者（分析了20例），他们的年龄中位数[四分位间距]为21[14 - 36]个月。不同设置下TV无显著差异。与单独使用4 cmH₂O的PEEP相比，PSV时EELI的增加幅度更大（+0.60[0.48 - 0.91]任意单位）（单独使用4 cmH₂O的PEEP时为+0.39[0.20 - 0.06]任意单位，p = 0.005），且随着PSV水平升高EELI无变化（+0.66[0.40 - 1.22]任意单位）。使用PSV时肺通气的背侧部分减少，从SB - 面罩通气时的56%[45 - 63]降至4 cmH₂O PSV时的53%[43 - 56]（p = 0.002）和7 cmH₂O PSV时的47%[40 - 55]（p = 0.001）。
儿童吸入麻醉诱导期使用的呼吸机设置对肺通气有影响。儿童吸入麻醉诱导期的PSV可能独立于TV增加来恢复呼气末肺容量。
