Alveolar target ventilation and dead space in children under anaesthesia: The proventiped cohort study

Eur J Anaesthesiol. 2023 Jul 1;40(7):495-500. doi: 10.1097/EJA.0000000000001832. Epub 2023 Apr 12.

Abstract

Introduction: Ventilator settings in children under anaesthesia remain difficult because of the changes in the physiology and the high dead space.

Objective: To determine the alveolar minute-volume to sustain normocapnia in children under mechanical ventilation.

Design: A prospective observational study.

Settings: This study was performed between May and October 2019 in a tertiary care children's hospital.

Patients: Children between 2 months and 12 years, weighing between 5 and 40 kg, admitted for general anaesthesia.

Intervention: Volumetric capnography was used to estimate the alveolar and dead space volume (Vd).

Main outcome measures: Total and alveolar minute ventilation in (ml kg -1 min -1 ) over 100 breaths.

Results: Sixty patients were included comprising 20 per group: 5 to 10 kg (group 1), 10 to 20 kg (group 2), 20 to 40 kg (group 3). Seven patients were excluded for aberrant capnographic curves. After normalisation to weight, the median [IQR] tidal volume per kilogram was similar between the three groups: 6.5 ml kg -1 [6.0 to 7.5 ml kg -1 ], 6.4 ml kg -1 [5.7 to 7.3 ml kg -1 ], 6.4 ml kg -1 [5.3 to 6.8 ml kg -1 ]; P = 0.3. Total Vd (in ml kg -1 ) was negatively correlated to weight ( r = -0.62, 95% confidence interval -0.41 to -0.76, P < 0.001). The total normalised minute ventilation (ml kg -1 min -1 ) to obtain normocapnia was higher in group 1 than in group 2 and in group 3; 203 ml kg -1 min -1 [175 to 219 ml kg -1 min -1 ], 150 ml kg -1 min -1 [139 to 181 ml kg -1 min -1 ] and 128 ml kg -1 min -1 [107 to 157 ml kg -1 min -1 ]; P < 0.001 (mean ± SD), but (mean ± SD) alveolar minute ventilation was similar between the three groups; 68 ± 21 ml kg -1 min -1 .

Conclusion: Total dead space volume (including apparatus dead space) represents a major component of tidal volume in children less than 30 kg, when using large heat and moisture exchanger filters. The total minute ventilation necessary to achieve normocapnia decreased with increasing weight, while the alveolar minute ventilation remained constant.

Trial registration: ClinicalTrials.gov, identifier: NCT03901599.

Publication types

  • Observational Study

MeSH terms

  • Anesthesia*
  • Carbon Dioxide
  • Child
  • Cohort Studies
  • Humans
  • Respiration, Artificial
  • Respiratory Dead Space* / physiology
  • Tidal Volume

Substances

  • Carbon Dioxide

Associated data

  • ClinicalTrials.gov/NCT03901599