Intratidal recruitment/derecruitment persists at low and moderate positive end-expiratory pressure in paediatric patients.

Abstract In paediatric patients positive end-expiratory pressure (PEEP) is traditionally set lower than in adults. We investigated whether moderately higher PEEP improves respiratory mechanics and regional ventilation. Therefore, 40 children were mechanically ventilated with PEEP 2 and 5 cmH 2 O. Volume-dependent compliance profiles were analysed as a measure of intratidal recruitment/derecruitment. Regional ventilation was assessed using electrical impedance tomography. Mean compliance was 17.9 ± 9.9 mL cmH 2 O ‐1 (PEEP 2 cmH 2 O), and 19.0 ± 10.9 mL cmH 2 O ‐1 (PEEP 5 cmH 2 O, p  2 O, and 36% at PEEP 5 cmH 2 O. Children showing strong recruitment/derecruitment were 33 (PEEP 2 cmH 2 0) and 20 (PEEP 5 cmH 2 0) months younger than children showing moderate recruitment/derecruitment. A higher PEEP improved peripheral ventilation. In conclusion, mechanically ventilated paediatric patients undergo intratidal recruitment/derecruitment which occurs more prominently in younger than in older children. A PEEP of 5 cmH 2 O does not fully prevent intratidal recruitment/derecruitment but homogenizes regional ventilation in comparison to 2 cmH 2 O.