Intratidal recruitment/derecruitment persists at low and moderate positive end-expiratory pressure in paediatric patients

In paediatric patients positive end-expiratory pressure (PEEP) is traditionally set lower than in adults. We investigated whether moderately higher PEEP improves respiratory mechanics and regional ventilation. Therefore, 40 children were mechanically ventilated with PEEP 2 and 5 cmH(2)O. Volume-dependent compliance profiles were analysed as a measure of intratidal recruitment/derecruitment. Regional ventilation was assessed using electrical impedance tomography. Mean compliance was 17.9 +/- 9.9 mLcmH(2)O(-1) (PEEP 2 cmH(2)O), and 19.0 +/- 10.9 mL cmH(2)O(-1) (PEEP 5 cmH(2)O, p < 0.001). Strong intratidal recruitment/derecruitment occurred in 40% of children at PEEP 2 cmH(2)O, and 36% at PEEP 5 cmH(2)O. Children showing strong recruitment/derecruitment were 33 (PEEP 2 cmH(2)O) and 20 (PEEP 5 cmH(2)O) months younger than children showing moderate recruitment/derecruitment. A higher PEEP improved peripheral ventilation. In conclusion, mechanically ventilated paediatric patients undergo intratidal recruitment/derecruitment which occurs more prominently in younger than in older children. A PEEP of 5 cmH(2)O does not fully prevent intratidal recruitment/derecruitment but homogenizes regional ventilation in comparison to 2 cmH(2)O. (C) 2016 Elsevier B.V. All rights reserved.