Changes in ventilation distribution during general anesthesia measured with EIT in mechanically ventilated small children
Abstract Background Atelectasis during general anesthesia is a risk for perioperative complications. EIT measurements were performed in mechanically ventilated healthy children during elective surgery to demonstrate the changes in ventilation distribution during general anesthesia. The ventilation d...
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| 格式: | Article |
| 語言: | English |
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BMC
2023-04-01
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| 叢編: | BMC Anesthesiology |
| 主題: | |
| 在線閱讀: | https://doi.org/10.1186/s12871-023-02079-z |
| _version_ | 1827966103119200256 |
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| author | Dorothea Clasen Isabel Winter Stephan Rietzler Gerhard K. Wolf |
| author_facet | Dorothea Clasen Isabel Winter Stephan Rietzler Gerhard K. Wolf |
| author_sort | Dorothea Clasen |
| collection | DOAJ |
| description | Abstract Background Atelectasis during general anesthesia is a risk for perioperative complications. EIT measurements were performed in mechanically ventilated healthy children during elective surgery to demonstrate the changes in ventilation distribution during general anesthesia. The ventilation distribution was quantified by calculating the Global Inhomogeneity index (GI). Methods EIT measurements were performed in 23 children (9 weeks—10 years) without lung disease to detect changes in regional ventilation during elective surgery. Three previously defined time points were marked during the measurement: after intubation and start of pressure-controlled ventilation (PCV), change to pressure support ventilation (PSV), and after extubation (spontaneous breathing—SB). Ventilation distribution based on regions of interest (ROI) and changes in end-expiratory volume (∆EELV) were collected at these time points and compared. The Global Inhomogeneity index was calculated at the beginning of pressure-controlled ventilation (PCV). Results With increasing spontaneous breathing, dorsal recruitment of atelectasis occurred. The dorsal ventilation fraction increased over the time of general anesthesia with increasing spontaneous breathing, whereas the ventral fraction decreased relatively (Difference ± 5.5 percentage points respectively; 95% CI; 3.5—7.4; p < 0.001). With the onset of spontaneous breathing, there was a significant reduction in end-expiratory volume (Difference: 105 ml; 95% CI, 75–135; p < 0.001). The GI of the lung-healthy ventilated children is 47% (SD ± 4%). Conclusion Controlled ventilation of healthy children resulted in increased ventilation of the ventral and collapse of the dorsal lung areas. Restart of spontaneous breathing after cessation of surgery resulted in an increase in ventilation in the dorsal with decrease in the ventral lung areas. By calculating the GI, representing the ratio of more to less ventilated lung areas, revealed the presumed homogeneous distribution of ventilation. Trial registration ClinicalTrials.gov Registration ID: NCT04873999. First registration: 05/05/2021. |
| first_indexed | 2024-04-09T17:44:46Z |
| format | Article |
| id | doaj.art-2f90b35e86a34a1cb961da3f24f28e54 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-04-09T17:44:46Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-2f90b35e86a34a1cb961da3f24f28e542023-04-16T11:23:34ZengBMCBMC Anesthesiology1471-22532023-04-012311810.1186/s12871-023-02079-zChanges in ventilation distribution during general anesthesia measured with EIT in mechanically ventilated small childrenDorothea Clasen0Isabel Winter1Stephan Rietzler2Gerhard K. Wolf3Children’s Hospital Traunstein, Academic Teaching Hospital of Ludwig-Maximilians University MunichChildren’s Hospital Traunstein, Academic Teaching Hospital of Ludwig-Maximilians University MunichDipl. Physicist Stephan RietzlerChildren’s Hospital Traunstein, Academic Teaching Hospital of Ludwig-Maximilians University MunichAbstract Background Atelectasis during general anesthesia is a risk for perioperative complications. EIT measurements were performed in mechanically ventilated healthy children during elective surgery to demonstrate the changes in ventilation distribution during general anesthesia. The ventilation distribution was quantified by calculating the Global Inhomogeneity index (GI). Methods EIT measurements were performed in 23 children (9 weeks—10 years) without lung disease to detect changes in regional ventilation during elective surgery. Three previously defined time points were marked during the measurement: after intubation and start of pressure-controlled ventilation (PCV), change to pressure support ventilation (PSV), and after extubation (spontaneous breathing—SB). Ventilation distribution based on regions of interest (ROI) and changes in end-expiratory volume (∆EELV) were collected at these time points and compared. The Global Inhomogeneity index was calculated at the beginning of pressure-controlled ventilation (PCV). Results With increasing spontaneous breathing, dorsal recruitment of atelectasis occurred. The dorsal ventilation fraction increased over the time of general anesthesia with increasing spontaneous breathing, whereas the ventral fraction decreased relatively (Difference ± 5.5 percentage points respectively; 95% CI; 3.5—7.4; p < 0.001). With the onset of spontaneous breathing, there was a significant reduction in end-expiratory volume (Difference: 105 ml; 95% CI, 75–135; p < 0.001). The GI of the lung-healthy ventilated children is 47% (SD ± 4%). Conclusion Controlled ventilation of healthy children resulted in increased ventilation of the ventral and collapse of the dorsal lung areas. Restart of spontaneous breathing after cessation of surgery resulted in an increase in ventilation in the dorsal with decrease in the ventral lung areas. By calculating the GI, representing the ratio of more to less ventilated lung areas, revealed the presumed homogeneous distribution of ventilation. Trial registration ClinicalTrials.gov Registration ID: NCT04873999. First registration: 05/05/2021.https://doi.org/10.1186/s12871-023-02079-zGeneral anesthesiaVentilation distributionPediatricsEITGIARDS |
| spellingShingle | Dorothea Clasen Isabel Winter Stephan Rietzler Gerhard K. Wolf Changes in ventilation distribution during general anesthesia measured with EIT in mechanically ventilated small children BMC Anesthesiology General anesthesia Ventilation distribution Pediatrics EIT GI ARDS |
| title | Changes in ventilation distribution during general anesthesia measured with EIT in mechanically ventilated small children |
| title_full | Changes in ventilation distribution during general anesthesia measured with EIT in mechanically ventilated small children |
| title_fullStr | Changes in ventilation distribution during general anesthesia measured with EIT in mechanically ventilated small children |
| title_full_unstemmed | Changes in ventilation distribution during general anesthesia measured with EIT in mechanically ventilated small children |
| title_short | Changes in ventilation distribution during general anesthesia measured with EIT in mechanically ventilated small children |
| title_sort | changes in ventilation distribution during general anesthesia measured with eit in mechanically ventilated small children |
| topic | General anesthesia Ventilation distribution Pediatrics EIT GI ARDS |
| url | https://doi.org/10.1186/s12871-023-02079-z |
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