Determination of Optimal Positive End-expiratory Pressure Using Electrical Impedance Tomography in Children Under General Anesthesia: Comparison Between Supine and Prone Positions

Study Overview
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Brief Summary
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The purpose of this study was to determine the appropriate positive end-expiratory pressure (PEEP) using electrical impedance tomography (EIT) in children under general anesthesia and to investigate whether there is a difference between the supine and prone positions.

Official Title
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Determination of Optimal Positive End-expiratory Pressure Using Electrical Impedance Tomography in Children Under General Anesthesia: Comparison Between Supine and Prone Positions

Conditions
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General Anesthesia

Intervention / Treatment
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* Other: Exploration of optimal PEEP in supine and prone position


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children <= years of age who are scheduled for surgery in the prone position under general anesthesia Exclusion Criteria: Respiratory distress, bronchopulmonary dysplasia Pneumothorax Increased intracranial pressure History of airway surgery Cervical or thoracic surgery Pulmonary hypertension

Ages Eligible for Study
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Maximum Age: 1 Year

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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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Children <= 1 years old<br>Pediatric patients <= 1 years old of age scheduled for surgery in the prone position | Other: Exploration of optimal PEEP in supine and prone position<br>* General anesthesia is done in routine manner A sensor for electrical impedance tomography (EIT) is applied around the patient's chest. In supine position, lung recruitment maneuver is done, followed by decremental PEEP trial. Based on EIT parameter, optimal PEEP which induces minimal overdistension and collapse of lungs is determined. One hour after prone position, optimal PEEP is determined again.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Optimal PEEP level at spine position | Optimal PEEP level (cmH2O) determination using electrical impedance tomography at supine position | 10 minutes after intubation (supine) | 
| Optimal PEEP level at prone position | Optimal PEEP level (cmH2O) determination using electrical impedance tomography at prone position | 1 hour after prone positioning (prone) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dynamic compliance measured using Electrical impedance tomography | ventilation/pressure (ml/cmH2O) | until 1 hour after prone positioning | 
| regional ventilation delay measured using Electrical impedance tomography | ventilation time delay during one breath (no unit) | until 1 hour after prone positioning | 
| pulmonary opening pressure measured using Electrical impedance tomography | alveoli opening pressure (cmH2O) | until 1 hour after prone positioning | 
| atelectasis/overdistension ratio measured using Electrical impedance tomography | The degree comparing atelectasis and overdistension (no unit) | until 1 hour after prone positioning |