Protective Ventilation Based on Alveolar Ventilation in Children

Study Overview
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Brief Summary
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Protective ventilation decreased morbidity and mortality in adults' patients and is now a standard of care in intensive care unit and in anesthesiology. In children, there is no evidence in the literature to recommend protective ventilation during anaesthesia. Moreover the ratio of instrumental dead space to tidal volume is higher in children than in adults. Therefore, it is difficult to propose an optimal tidal volume for all children. The objective of this study is to evaluate the use of alveolar ventilation (estimated by the volumetric capnography) in children under anesthesia. The hypothesis is that in children, alveolar ventilation reported to ideal body weight is a constant to maintain normocarbia, unlike the tidal volume.

Official Title
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Feasibility of Protective Ventilation Based on the Alveolar Ventilation in Paediatric Anaesthesiology and Intensive Care.

Conditions
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Anesthesia, Peroperative Complication

Intervention / Treatment
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* Other: Alveolar ventilation monitoring estimated by the capnographic ventilation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children aged < 12 and Weight between 5 and 40kg General anesthesia Non-opposition of parents or legal guardians Exclusion Criteria: History of bronchodysplasia or laryngo tracheo malacia, cyanotic heart disease or neuromuscular disease Airleaks > 10% Bronchospasm during anesthesia

Ages Eligible for Study
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Minimum Age: 2 Months
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Children between 5-10Kg<br>Children with a body weight between 5-10Kg | Other: Alveolar ventilation monitoring estimated by the capnographic ventilation<br>* Children are monitored using end-tidal CO2, Transcutaneous CO2 and volumetric capnographic. Respiratory rate is set using textbooks and guidelines (pediatric advanced life support). The physician in charge adapts the volume to target a CO2 between 38 and 42 mmHg. Data are recorded after a stabilization period of at least 5 minutes.<br>|
| Children between 10-20Kg<br>Children with a body weight between 10-20Kg | Other: Alveolar ventilation monitoring estimated by the capnographic ventilation<br>* Children are monitored using end-tidal CO2, Transcutaneous CO2 and volumetric capnographic. Respiratory rate is set using textbooks and guidelines (pediatric advanced life support). The physician in charge adapts the volume to target a CO2 between 38 and 42 mmHg. Data are recorded after a stabilization period of at least 5 minutes.<br>|
| Children between 20-40Kg<br>Children with a body weight between 20-40Kg | Other: Alveolar ventilation monitoring estimated by the capnographic ventilation<br>* Children are monitored using end-tidal CO2, Transcutaneous CO2 and volumetric capnographic. Respiratory rate is set using textbooks and guidelines (pediatric advanced life support). The physician in charge adapts the volume to target a CO2 between 38 and 42 mmHg. Data are recorded after a stabilization period of at least 5 minutes.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Determination of target alveolar minute volume to maintain normocapnia in children without mechanical ventilation. | The minute alveolar ventilation estimated by the volumetric capnography reported to the ideal body weight based on 100 breaths (expressed in ml/Kg/min). | 5 minutes after hemodynamic and ventilatory stabilization period |