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Airway closure in anesthetized infants and children: influence of inspiratory pressures and volumes

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Background:

Cyclic opening and closing of lung units during tidal breathing may be an important cause of iatrogenic lung injury. We hypothesized that airway closure is uncommon in children with healthy lungs when inspiratory pressures are kept low, but paradoxically may occur when inspiratory pressures are increased. Methods:

Elastic equilibrium volume (EEV) and closing capacity (CC) were measured with a tracer gas (SF6) technique in 11 anesthetized, muscle-relaxed, endotracheally intubated and artificially ventilated healthy children, aged 0.6–13 years. Airway closing was studied in a randomized order at two inflation pressures, +20 or +30 cmH2O, and CC and CC/EEV were calculated from the plots obtained when the lungs were exsufflated to −20 cmH2O. (CC/EEV >1 indicates that airway closure might occur during tidal breathing). Furthermore, a measure of uneven ventilation, multiple breath alveolar mixing efficiency (MBAME), was obtained. Results:

Airway closure within the tidal volume (CC/EEV >1) was observed in four and eight children (not significant, NS) after 20 and 30 cmH2O inflation, respectively. However, CC30/EEV was >CC20/EEV in all children (P≤0.001). The MBAME was 75±7% (normal) and did not correlate with CC/EEV. Conclusion:

Airway closure within tidal volumes may occur in artificially ventilated healthy children during ventilation with low inspiratory pressure. However, the risk of airway closure and thus opening within the tidal volume increases when the inspiratory pressures are increased.
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Keywords: airway closure; anesthesia; functional residual capacity; multibreath washout; pediatric; sulfur hexafluoride

Document Type: Research Article

Affiliations: 1: Department of Anesthesia and Intensive Care, Landspitalinn University Hospital, Iceland, 2: Department of Anesthesia and Intensive Care, University Hospital, Lund, Sweden, 3: Department of Anesthesiology, Children's Hospital and Regional Medical Center, Seattle, USA and 4: Department of Anesthesiology, Gentofte University Hospital, Hellerup, Denmark

Publication date: 2002-05-01

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