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Gas Exchange during Controlled Ventilation in Children with Normal and Abnormal Pulmonary Circulation

A Study Using the Single Breath Test for Carbon Dioxide

Received from the Departments of Anesthesiology and Clinical Physiology, University Hospital, Lund, Sweden.

Abstract

Carbon dioxide single breath tests (SBT-CO₂) were obtained during anesthesia and controlled ventilation in 42 children about to undergo thoracic surgery. The tests were obtained with a computerized system based on the Servo ventilator. The system made on-line corrections for compressed volume, apparatus deadspace, and rebreathing. Children with normal pulmonary circulation had excellent gas exchange with high PaO₂ values, a mean alveolar deadspace fraction (V_Dalv/VTalv) of 0.10, and a gently sloping phase III of SBT-CO₂ Children with pulmonary hyperperfusion (left to right shunting) due to an atrial septal defect or a ventrical septal defect had significantly lower PaO₂ values, steeper phase III slopes, and a greater spead of values for V_DalvlVTalv. Children with pulmonary hypoperfusion due to pulmonary stenosis in combination with intracardiac right to left shunting had extremely low PaO₂ values, and "adult" values for V_Dalv/VTalv. They required increased ventilation to maintain CO₂ homeostasis. In the pooled material, the airway deadspace was strongly correlated to height, weight, and age. The airway deadspace was unaffected when tidal volume was increased by 37%, and ventilatory frequency simultaneously reduced by 30%, a maneuver that left alveolar ventilation unchanged. This is probably because an end-inspiratory pause was used; when frequency is reduced the length of the end-inspiratory pause increases, allowing proximal diffusion of the alveolar/fresh gas interface.

Key Words: VENTILATION—pediatric • ANESTHESIA—pediatric

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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