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PEDIATRIC ANESTHESIA

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

Britta S. von Ungern-Sternberg, MD^*, Adrian Regli, MD, Andreas Schibler, MD, Jürg Hammer, MD, Franz J. Frei, MD^*, and Thomas O. Erb, MD, MHS^*

From the *Division of Anesthesia, University Children’s Hospital, Basel, Switzerland; Department of Anesthesia, University of Basel Hospital, Basel, Switzerland; Division of Pediatric Intensive Care, Mater Misericordiae Hospital, Brisbane, Australia; and Division of Pneumology and Intensive Care, University Children’s Hospital, Basel, Switzerland.

Address correspondence and reprint requests to B. S. von Ungern- Sternberg, MD, Division of Anesthesia, University Children’s Hospital, Roemergasse 8, CH-4005 Basel, Switzerland. Address e-mail to bvonungern{at}uhbs.ch.

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.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999