Physiologie und Pathophysiologie des respiratorischen Systems

Positive pressure ventilation in children is associated with problems similar to those in the adults: development of atelectasis and barotrauma. During anesthesia atelectasis develop in up to 90% of patients, requiring the use of higher inspiratory pressure to recruit the collapsed lung regions. Especially in the preterm, newborn and younger infants, prolonged ventilation disturbs the anatomical structure of the soft and vulnerable immature airways and their subsequent growth and development, leading to tracheomegaly, tracheal collapse, and bronchopulmonary dysplasia and predisposing to bronchial obstruction. On the basis of pathophysiologic knowledge and studies of ventilation in children, protective modes of ventilation have evolved. They allow to reopen atelectatic lung regions without overdistension. Through solid knowledge of the underlying pediatric physiology and pathophysiology, the required ventilation management can be optimally adjusted to the young patients in order to achieve the best long-term outcomes.