ZEHRA HATİPOĞLU, Oya H. YÜREGİR, Dilek ÖZCENGİZ

Intraoperative Mechanical Ventilation Strategies in Newborns and Children in Turkey: A Survey Investigation

Objective: Most children under general anesthesia need mechanical ventilation (MV), but it has been reported in the literature that many parameters for this application are derived from adult patients. There is lack of literature about intraoperative MV for children. We conducted this sur- vey to seek an answer for the question “How intraoperative respiratory parameters based on MV are managed for newborns and children among Turkish anesthesiologists?”. Method: A questionnaire containing 30 questions was sent to anesthesiologists. This survey col- lected information on clinical practice related to MV modes, tidal volume, positive end-expiratory pressure (PEEP), fraction of inspired oxygen (FiO 2 ), respiratory rate, monitoring of peripheral oxygen saturation (SpO 2 ) and end-tidal carbon dioxide (EtCO 2 ) and recruitment maneuvers (RMs). Results: A total of 148 anesthesiologists and anesthesia residents responded to this survey. Of these respondents, 77% were working at a university hospital. More than 60% of respondents were using volume-controlled modes for newborns and children. The most commonly used tidal volume and PEEP values were 6-8 mL kg -1 and 3-4 cmH 2 O, respectively. Monitorization, including SpO 2 and EtCO 2 was used by over 85% of respondents, while 75.7% of them were using recruit- ment maneuvers (RMs), which were often (55.4%) used during hypoxia with application of manual inspiratory pressure (71.6%). Conclusion: The results of the present study indicate differences with the existing literature data. However, information about intraoperative application of mechanical ventilation in pediatric patients is limited, and there is a need for further study on this field.

Türkiye’de Yenidoğan ve Çocuklarda Intraoperatif Mekanik Ventilasyon Stratejileri: Anket Çalışması

Amaç: Genel anestezi altındaki çocukların çoğunun mekanik ventilasyona gereksinimi vardır. Ancak literatürde, bu uygulama için birçok parametrenin yetişkin hastalar örnek alınarak uygu- landığı bildirilmiştir. Çocuklar için intraoperatif mekanik ventilasyon hakkında literatür eksikliği bulunmaktadır. Bu anketin amacı, Türk anesteziyologlar arasında, “Yenidoğan ve çocuklarda mekanik ventilasyona dayalı intraoperatif solunum parametreleri nasıl yönetilmektedir?” sorusu- na yanıt aramaktır. Yöntem: Anestezistlere yönelik 30 soru içeren anket uygulandı. Bu ankette mekanik ventilasyon modları, tidal volüm, pozitif son ekspiratuar basınç (PEEP), inspire edilen oksijen fraksiyonu (FiO 2 ), solunum sayısı, periferal oksijen saturasyonu (SpO 2 ), end-tidal karbondioksit (EtCO 2 ) ve recruit- ment manevraları ile ilgili klinik uygulamalar hakkında bilgi toplandı. Bulgular: Bu ankete toplam 148 anestezi uzmanı ve anestezi asistanı yanıt verdi. Ankete katılanla- rın %77’si üniversite hastanesinde çalışıyordu. Katılımcıların %60’ından fazlası yenidoğanlarda ve çocuklarda volüm kontrollü modu tercih etmekteydi. En sık kullanılan tidal volüm ve PEEP değerle- ri sırasıyla 6-8 mL kg -1 ve 3-4 cmH 2 O idi. SpO 2 ve EtCO 2 içeren monitörizasyon %85’in üzerinde bir oranda uygulanmakta idi. Recruitment manevrasının kullanımı %75.7 idi. Bu teknik, sıklıkla (%55.4) hipoksi sırasında manuel inspiratuar basınç (%71.6) kullanılarak uygulanmakta idi. Sonuç: Bu çalışmanın sonuçları mevcut literatürle farklılıklar göstermektedir. Bununla birlikte, pediyatrik hastalarda intraoperatif mekanik ventilasyon uygulamaları ile ilgili bilgiler sınırlıdır ve daha fazla çalışmaya gereksinim vardır.

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