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Effect of Equal Ratio Ventilation on Respiratory Mechanics and Oxygenation During Volume-Controlled Ventilation in Pediatric Patients

 Ha Yeon Kim  ;  Sung Yeon Ham  ;  Eun Jung Kim  ;  Hei Jin Yoon  ;  Seung Yeon Choi  ;  Bon Nyeo Koo 
 YONSEI MEDICAL JOURNAL, Vol.62(6) : 503-509, 2021-06 
Journal Title
Issue Date
Blood Gas Analysis ; Child ; Humans ; Lung ; Lung Compliance ; Pulmonary Gas Exchange ; Respiration, Artificial* ; Respiratory Mechanics*
Blood gas analysis ; exhalation ; inhalation ; pediatrics ; positive pressure breathing ; respiratory mechanics
Purpose: Children have few small alveoli, which reduce lung compliance; in contrast, their cartilaginous rib cage makes their chest wall highly compliant. This combination promotes lung collapse. Prolonged inspiratory to expiratory (I:E) ratio ventilation is used to optimize gas exchange and respiratory mechanics in surgery. However, the optimal ratio is unclear in children. We hypothesized that, compared to a 1:2 I:E ratio, a 1:1 I:E ratio would improve dynamic compliance and oxygenation, and affect the peak airway pressure in pediatric patients undergoing surgery.

Materials and methods: Forty-eight patients aged ≤6 years who were scheduled to undergo surgery under general anesthesia with an arterial line were randomly allocated to receive 1:1 (group 1:1) or 1:2 (group 1:2) I:E ratio ventilation. Airway pressure, respiratory system compliance, and arterial blood gas analyses were compared between groups immediately after induction (T0), 30 min after induction (T1), 60 min after induction (T2), immediately after surgery (T3), and on arrival at the post-anesthesia care unit (T4).

Results: Peak and plateau airway pressures were significantly lower in group 1:1 than in group 1:2 at T1 (p=0.044 and 0.048, respectively). The dynamic and static compliances were significantly higher in group 1:1 than in group 1:2 at T1 (p=0.044 and 0.045, respectively). However, the partial pressure of oxygen did not significantly differ between groups.

Conclusion: Compared to a 1:2 I:E ratio, a 1:1 I:E ratio improved dynamic compliance and lowered the peak airway pressure without complications in pediatric patients. Nevertheless, our results do not support its use solely for improving oxygenation.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Koo, Bon-Nyeo(구본녀) ORCID logo https://orcid.org/0000-0002-3189-1673
Kim, Eun Jung(김은정) ORCID logo https://orcid.org/0000-0002-5693-1336
Yoon, Hei Jin(윤혜진)
Choi, Seung Yeon(최승연)
Ham, Sung Yeon(함성연) ORCID logo https://orcid.org/0000-0001-8619-4595
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