Effect of general anesthesia and controlled mechanical ventilation on pulmonary ventilation distribution assessed by electrical impedance tomography in healthy children
Milena S Nascimento, Celso M Rebello, Eduardo L V Costa, Leticia C Corrêa, Glasiele C Alcala, Felipe S Rossi, Caio C A Morais, Eliana Laurenti, Mauro C Camara, Marcelo Iasi, Maria L P Apezzato, Cristiane do Prado, Marcelo B P Amato, Milena S Nascimento, Celso M Rebello, Eduardo L V Costa, Leticia C Corrêa, Glasiele C Alcala, Felipe S Rossi, Caio C A Morais, Eliana Laurenti, Mauro C Camara, Marcelo Iasi, Maria L P Apezzato, Cristiane do Prado, Marcelo B P Amato
Abstract
Introduction: General anesthesia is associated with the development of atelectasis, which may affect lung ventilation. Electrical impedance tomography (EIT) is a noninvasive imaging tool that allows monitoring in real time the topographical changes in aeration and ventilation.
Objective: To evaluate the pattern of distribution of pulmonary ventilation through EIT before and after anesthesia induction in pediatric patients without lung disease undergoing nonthoracic surgery.
Methods: This was a prospective observational study including healthy children younger than 5 years who underwent nonthoracic surgery. Monitoring was performed continuously before and throughout the surgical period. Data analysis was divided into 5 periods: induction (spontaneous breathing, SB), ventilation-5min, ventilation-30min, ventilation-late and recovery-SB. In addition to demographic data, mechanical ventilation parameters were also collected. Ventilation impedance (Delta Z) and pulmonary ventilation distribution were analyzed cycle by cycle at the 5 periods.
Results: Twenty patients were included, and redistribution of ventilation from the posterior to the anterior region was observed with the beginning of mechanical ventilation: on average, the percentage ventilation distribution in the dorsal region decreased from 54%(IC95%:49-60%) to 49%(IC95%:44-54%). With the restoration of spontaneous breathing, ventilation in the posterior region was restored.
Conclusion: There were significant pulmonary changes observed during anesthesia and controlled mechanical ventilation in children younger than 5 years, mirroring the findings previously described adults. Monitoring these changes may contribute to guiding the individualized settings of the mechanical ventilator with the goal to prevent postoperative complications.
Conflict of interest statement
Letícia C. Corrêa and Glasiele C. Alcala are employees of Timpel S.A.; Eduardo Leite and Felipe S. Rossi are Timpel S.A. consultants, Marcelo B. P. Amato is Timpel S.A. consultant and minority shareholder. The other authors declare no competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
Copyright: © 2023 Nascimento et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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