Document Detail


The impact of positive end-expiratory pressure on functional residual capacity and ventilation homogeneity impairment in anesthetized children exposed to high levels of inspired oxygen.
MedLine Citation:
PMID:  17513627     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: High fractions of inspired oxygen (Fio2) result in resorption atelectasis shortly after their application. However, the impact of different levels of Fio2 and their interaction with positive end-expiratory pressure (PEEP) on functional residual capacity (FRC) and ventilation distribution is unknown in anesthetized children. We hypothesized that the use of a Fio2 of 1.0 results in a decrease of FRC and ventilation homogeneity compared with that of a Fio2 of 0.3, and that this decrease is prevented by PEEP of 6-cm H2O compared to a PEEP of 3-cm H2O. METHODS: Forty-six children (3-6 yr) without cardiopulmonary disease were randomly allocated to receive PEEP of 6-cm H2O (PEEP 6 group) during the entire study period or PEEP of 3-cm H2O (PEEP 3 group). The order of the Fio2 (0.3 or 1.0) was also randomized. A defined recruitment maneuver was performed after tracheal intubation and 5 min later the first measurement. This procedure was then repeated with the second Fio2 level. FRC and lung clearance index (LCI) were calculated by a blinded observer. RESULTS: While FRC (mean +/- sd) was similar at both levels of Fio2 (0.3: 25.6 +/- 2.9 mL/kg vs 1.0: 25.6 +/- 2.8 mL/kg, P = 0.189) in the PEEP 6 group, FRC decreased in the PEEP 3 group (0.3: 24.9 +/- 3.8 vs 1.0: 21.7 +/- 4.1, P < 0.0001). Furthermore, with continuous PEEP of 6-cm H2O a similar LCI was observed at both levels of Fio2 (0.3: 6.45 +/- 0.4 vs 6.43 +/- 0.4, P = 0.668) while LCI increased at the higher Fio2 in the PEEP 3 group (0.3: 6.5 +/- 0.5 vs 1.0: 7.7 +/- 1.2, P < 0.0001). CONCLUSIONS: During the application of a very low PEEP of 3-cm H2O, FRC and ventilation distribution decreased significantly at an Fio2 of 1.0 compared with that at an Fio2 of 0.3. This decrease could be counterbalanced by the administration of PEEP of 6-cm H2O, indicating that a low level of PEEP is sufficient to maintain FRC and ventilation distribution regardless of the oxygen concentration.
Authors:
Britta S von Ungern-Sternberg; Adrian Regli; Andreas Schibler; Jürg Hammer; Franz J Frei; Thomas O Erb
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  104     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-05-21     Completed Date:  2007-06-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1364-8, table of contents     Citation Subset:  AIM; IM    
Affiliation:
Division of Anesthesia, University Children's Hospital, Basel, Switzerland. bvonungern@uhbs.ch
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MeSH Terms
Descriptor/Qualifier:
Anesthesia, General / methods
Child
Child, Preschool
Female
Functional Residual Capacity / drug effects,  physiology
Humans
Inhalation / drug effects,  physiology*
Male
Oxygen / administration & dosage*
Positive-Pressure Respiration* / methods
Pulmonary Ventilation / drug effects,  physiology*
Residual Volume / drug effects,  physiology
Total Lung Capacity / physiology*
Chemical
Reg. No./Substance:
7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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