• J Clin Anesth · Feb 2025

    Observational Study

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

    • Viviane Lauret, Claude Guerin, Sirine Boussena, Mathilde De-Queiroz, Lionel Bouvet, and Florent Baudin.
    • Hospices Civils de Lyon, Département d'anesthésie, Hôpital Femme Mère Enfant, F - 69500 Bron, France.
    • J Clin Anesth. 2025 Feb 1; 101: 111710111710.

    Study ObjectiveTo 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.DesignProspective observational clinical pilot-study.SettingUniversity Children's Hospital of Lyon, France.PatientsChildren without significant comorbidity (ASA 1 or 2) undergoing planned or unplanned surgery with inhalational induction of anesthesia.InterventionAfter 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.MeasurementsChildren 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 ResultsTwenty-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).ConclusionThe 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.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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