Peak intratracheal pressure during controlled ventilation in infants and children

The mathematical relationship between peak ventilator breathing system pressure displayed on the digital meter of the Siemens SV900C ventilator, and peak intratracheal pressure measured at the distal end of the tracheal tube, was defined and incorporated into a computer program. The mean difference between peak airway pressure calculated by the computer and directly measured peak intratracheal pressure was 0.02 kPa (SD 0.10) in 18 infants and children. The mean difference between ventilator breathing system pressure and intratracheal pressure in the same group was 0.82 kPa (SD 0.91). Bench tests established that the decrease in peak pressure displayed by the ventilator (from 1.36 to 0.38 kPa) while inspiratory time was increased from 20 to 80% of the respiratory period, concealed an increase (from 0.2 to 0.38 kPa) in intratracheal pressure which occurs during this process; and that the large increase in pressure displayed by the ventilator (from 0.3 to 6 kPa) while respiratory frequency was increased from 20 to 120 breaths/minute, concealed a small increase in peak intratracheal pressure (0.2-0.3 kPa) which occurs during this process. These changes were accurately predicted by the computer program. The increase in intratracheal pressure associated with prolonged inspiratory times explains the high incidence of barotrauma which has recently been associated with this procedure in infants.