Ventilation peropératoire en pédiatrie

Invasive mechanical ventilation is required when children undergo anaesthesia for any procedure. Airway and respiratory complications are the most common causes of morbidity and mortality during general anaesthesia in children. Among the many factors that make children, particularly newborns and infants, vulnerable to hypoxia when undergoing sedation or anaesthesia are alterations in lung mechanics, with reduced functional residual capacity and ventilation inhomogeneity with atelectasis. Based on available paediatric data, lung-protective mechanical ventilation strategy should be applied. For the induction of anaesthesia, pressure support allows preventing hypoventilation. During the intraoperative period, it may be argued that targeting a tidal volume between 6 and 8 mL/kg IBW is justifiable for paediatric ventilation, but that VT > 10 mL/kg should be avoided. A positive end-expiratory pressure (≥ 5 cmH2O) associated with recruitment manoeuvres may improve the gas exchange during general anaesthesia and prevent atelectasis. Pressure-controlled ventilation with a decelerating flow pattern may be recommended specially in newborns and infants.