Schranc et al. Flow-controlled ventilation maintains gas exchange and lung aeration in a pediatric model of healthy and injured lungs: A randomized cross-over experimental study. Front Pediatr. 2022

This porcine experimental study represents the first investigation of the feasibility of flow-controlled ventilation for a pediatric population. In a randomized cross-over study, Prof. Albu and colleagues evaluate the effect of FCV compared to pressure-regulated volume control (PRVC) in ten piglets (~10 kg body weight) before and after lung injury. Ventilation sequences included one hour of FCV followed by one hour PRVC, or vice versa, before and after inducing lung injury using surfactant depletion and a period of injurious ventilation. Ventilation settings were attempted to be kept comparable with both ventilation modes, with a set PEEP of 5 mbar and target tidal volumes of 7 ml/kg. Results showed no measurable effects on respiratory system mechanics when comparing both ventilation modalities. FCV, similarly to PRCV, allowed adequate gas exchange with sufficient CO₂ elimination in both healthy and injured lungs. With FCV, lower PaO₂/FiO₂ ratios and a slightly higher intrapulmonary shunt were observed, which may be related to the increased dead space ventilation during FCV. In healthy lungs, FCV provided a significantly elevated global lung aeration, as demonstrated by EIT measurements. The authors conclude that the use of flow-controlled ventilation may be extended to pediatric populations with healthy and injured lungs, potentially offering an alternative protective ventilation strategy. Further research is required to confirm the clinical value of FCV in this setting.