Ventilation of Children in the Operating Room

Ventilation of Children in the Operating Room

Session took place on Saturday 2 June

This refresher course on ventilation of children in the operating room was delivered by Professor Walid Habre, Head of the Unit for Anaesthesiological Investigations and Senior Consultant, Paediatric Anaesthesia, Geneva University Hospitals, Switzerland.

He discussed how the large ESA Clinical Trials Network (CTN) prospective cohort study, APRICOT, revealed a large variability of anaesthesia practice across the 33 European countries studied. “More importantly, ventilation practices were not consistent with lung protection strategies,” explained Professor Habre. “Furthermore, the ventilator settings were not in adapted to the mechanical and physiological properties of the paediatric lungs.”

As a result, this refresher course reviewed the physiological characteristics of the neonatal, infant and paediatric respiratory system that dictate the ventilator settings in this population. Factors contributing to lung heterogeneity under anaesthesia in children were also discussed in light of the viscoelastic properties of the lung. The current available evidence for the choice of the ventilation in children was discussed and hints on how to adjust the controlled ventilation to decrease the deleterious effects on haemodynamics and cardiac output were provided.

Professor Habre highlighted that, in reality, there are 3 important modes that anaesthesiologists should master when ventilating children.

He said: “First, pressure support should be always considered when a child is under spontaneous ventilation. This mode allows to overcome the resistance of the airways and/or apparatus, decreases the work of breathing and maintains adequate ventilation. Applying pressure-controlled ventilation requires the understanding of the important role of the inspiratory time in the presence of a decelerating flow to ensure a complete alveolar recruitment in a viscoelastic system. Finally, the most protective ventilation mode is the pressure regulated volume-controlled mode or volume guaranteed, which matches the neonatal and infant physiology with the continuous changes in lung compliance and should be always used during surgical procedures that alter this lung compliance.”

He concluded: “All ventilation strategies should take into account the restoration of the functional residual capacity by applying recruitment manoeuvres and a positive end-expiratory positive pressure. Ventilation is an essential component of anaesthesia management for ensuring optimal gas exchange while avoiding hypocapnia, responsible for a cerebral assault in neonates and infants.”