Impact of tracheal intubation and PEEP on pediatric respiratory mechanics

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Created On: 29/04/2026

Evidence on the impact of tracheal intubation, positive end-expiratory pressure (PEEP), and mechanical ventilation on respiratory mechanics in anesthetized children remains limited.

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Key take away

PEEP partially counteracts intubation-induced deterioration in pediatric respiratory mechanics but increases mechanical power during ventilation.

Background

Evidence on the impact of tracheal intubation, positive end-expiratory pressure (PEEP), and mechanical ventilation on respiratory mechanics in anesthetized children remains limited. This study explored how these interventions influence lung function in pediatric patients without pre-existing lung disease undergoing general anesthesia.

Method

This prospective crossover physiologic study included kids under 15 years scheduled for elective surgery. After anesthesia stimulation and neuromuscular blockade, volume-controlled ventilation was applied. Respiratory mechanics were evaluated during mask ventilation and following endotracheal intubation, at PEEP 0 and 5 cmH2O. Key variables encompassed peak inspiratory pressure (PIP), plateau pressure (PPLAT), total PEEP, airway resistance, respiratory system compliance, driving pressure, and mechanical power, analyzed using a mixed linear regression model.

Result

A total of 60 kids (median age 58 months) were analyzed. Tracheal intubation worsened respiratory mechanics, increasing PIP–PPLAT by 23.9%, airway resistance by 16.4%, and driving pressure by 20.4%, while reducing compliance by 14% (all statistically significant). In contrast, PEEP during mask ventilation improved lung mechanics, reducing driving pressure by 29.1% and increasing compliance by 46.7%.

When combined with intubation, PEEP partially reversed these adverse effects, lowering driving pressure by 7.9% and improving compliance by 19.6%. However, mechanical power increased markedly with PEEP, rising by 50% during mask ventilation and 83.3% after intubation. Younger children (<2 years) portrayed higher airway resistance across all ailments, although trends in driving pressure and compliance were similar to older children.

Conclusion

Tracheal intubation impaired respiratory mechanics in children, while PEEP provided partial physiological benefit by improving compliance and reducing driving pressure. Despite these benefits, the associated increase in mechanical power may raise the risk of ventilatory stress, emphasizing the requisition for careful optimization of pediatric ventilation strategies.