Calculating intrinsic positive end‐expiratory pressure from end‐expiratory flow in mechanically ventilated children — a study in physical models of the pediatric respiratory system

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Abstract: Rationale
The high resistance of pediatric endotracheal tubes (ETTs) exposes mechanically ventilated children to a particular risk of developing intrinsic positive end-expiratory pressure (iPEEP). To date, determining iPEEP at the bedside requires the execution of special maneuvers, interruption of ventilation, or additional invasive measurements. Outside such interventions, iPEEP may be unrecognized.

Objective
To develop a new approach for continuous calculation of iPEEP based on routinely measured end-expiratory flow and ETT resistance.

Methods
First, the resistance of pediatric ETTs with inner diameter from 2.0 to 4.5 mm were empirically determined. Second, during simulated ventilation, iPEEP was either calculated from the measured end-expiratory flow and ETT's resistance (iPEEPcalc) or determined with a hold-maneuver available at the ventilator (iPEEPhold). Both estimates were compared with the end-expiratory pressure measured at the ETT's tip (iPEEPdirect) by means of absolute deviations.

Results
End-expiratory flow and iPEEP increased with decreasing ETT inner diameter and with higher respiratory rates. iPEEPcalc and iPEEPhold were comparable and indicated good correspondence with iPEEPdirect. The largest absolute mean deviation was 1.0 cm H2O for iPEEPcalc and 1.1 cm H2O for iPEEPhold.

Conclusion
We conclude that iPEEP can be determined from routinely measured variables and predetermined ETT resistance, which has to be confirmed in the clinical settings. As long as this algorithm is not available in pediatric ICU ventilators, nomograms are provided for estimating the prevailing iPEEP from end-expiratory flow

Location
Deutsche Nationalbibliothek Frankfurt am Main
Extent
Online-Ressource
Language
Englisch
Notes
Pediatric pulmonology. - 59, 3 (2024) , 766-773, ISSN: 1099-0496

Classification
Medizin, Gesundheit

Event
Veröffentlichung
(where)
Freiburg
(who)
Universität
(when)
2024
Creator

DOI
10.1002/ppul.26828
URN
urn:nbn:de:bsz:25-freidok-2427145
Rights
Open Access; Der Zugriff auf das Objekt ist unbeschränkt möglich.
Last update
14.08.2025, 2:20 PM CEST

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Associated

Time of origin

  • 2024

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