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Invasive and Noninvasive Measurement of the Respiratory Deadspace in Anesthetized Children with Cardiac Disease

The Department of Anesthesiology, University Hospital, Lund, Sweden.

Abstract

To compare the magnitude of the different "invasive" and "noninvasive" dead space variables and the effect on them of ventilator setting, CO₂ single breath tests (SBT-CO₂) were obtained using an on-line computerized si/stem based on the Servo ventilator and CO₂, Analyzer 930, in 50 children anesthetized for cardiac surgery. The variables were the airway dead space (V_Daw), Bohr's dead space (V_DBohr) obtained noninvasively using end-tidal PCO₂ (PETCO₂) foralveolar PCO₂ in the dead space equation, and the physiologic dead space, V_Dphys. In 42 children with normal single breath tests, V_Daw was two-thirds of V_DBohr; in 9 children in whom phase III of SBT-CO₂ (the "alveolar plateau") was steeper than normal, it was only half of V_DBohr. Steeper slopes of phase III were seen particularly in the present of left-right (LR) shunting. V_Dphys was very similar in magnitude to V_DBohr in all children, except those with right-left (RL) shunts. V_Daw was the major component of V_Dphys only in children with normal arterial-end-tidal PCO₂ differences, i.e., those without RL shunts. When two ventilator frequencies giving the same alveolar ventilation were compared in children with normal gas exchange, V_DBohr as a fraction of tidal volume was least at the lower frequency, as it also is in adults. The data confirm that noninvasive CO₂ monitoring and measurement of dead-space gives useful indexes of the adequacy of ventilation in all children except those with RL shunts.

Key Words: ANESTHESIA—pediatric. • LUNG—dead space in children. • HEART—cardiac disease and respiratory dead space.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999