{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T08:56:48Z","timestamp":1792313808914,"version":"4.4.0"},"reference-count":25,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,3,22]],"date-time":"2025-03-22T00:00:00Z","timestamp":1742601600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2025,7]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Procedural sedation interferes with respiratory dynamics in pediatric patients. It reduces lung compliance, causing the closing volume to exceed the functional residual capacity, which can result in airway collapse, atelectasis, and periods of silent desaturation.<\/jats:p>\n <\/jats:sec>\n \n Aim<\/jats:title>\n \n Aims of the study were to clarify the impact of intravenous propofol sedation on ventilation distribution and to evaluate the potential benefits of noninvasive respiratory support (\n NRS<\/jats:styled-content>\n ) in restoring the original ventilation distribution pattern by applying the electrical impedance tomography technology.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Single\u2010center physiological randomized crossover study comparing two 20\u2010min steps of\n NRS<\/jats:styled-content>\n delivered as continuous positive airway pressure (\n CPAP<\/jats:styled-content>\n ) and noninvasive ventilation (\n NIV<\/jats:styled-content>\n ) at different time points: (1) spontaneous breathing (\n SB<\/jats:styled-content>\n \u20101); (2) spontaneous breathing during sedation (\n SB<\/jats:styled-content>\n \u20102); (3)\n CPAP<\/jats:styled-content>\n during sedation; (4)\n NIV<\/jats:styled-content>\n during sedation; (5) spontaneous breathing after sedation discontinuation (\n SB<\/jats:styled-content>\n \u20103). Primary endpoint was regional ventilation delay 40% (\n RVD40<\/jats:styled-content>\n %). Secondary outcomes were global index (\n GI<\/jats:styled-content>\n ), end\u2010expiratory lung impedance (\n EELI<\/jats:styled-content>\n ), and center of ventilation (\n CoV<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Thirteen children were enrolled.\n RVD40<\/jats:styled-content>\n % increased during\n SB<\/jats:styled-content>\n \u20102 compared to\n SB<\/jats:styled-content>\n \u20101 (\n p\u2009=<\/jats:italic>\n \u20090.014).\n NIV<\/jats:styled-content>\n was effective in reducing it compared to\n CPAP<\/jats:styled-content>\n (\n p<\/jats:italic>\n \u2009=\u20090.009) and\n SB<\/jats:styled-content>\n \u20103 (\n p<\/jats:italic>\n \u2009=\u20090.015).\n NIV<\/jats:styled-content>\n was also effective in restoring ventilation homogeneity and lung volume compared to\n SB<\/jats:styled-content>\n \u20102 by decreasing\n GI<\/jats:styled-content>\n (\n p<\/jats:italic>\n \u2009=\u20090.035) and restoring\n EELI<\/jats:styled-content>\n (\n p<\/jats:italic>\n \u2009=\u20090.002). During\n NIV<\/jats:styled-content>\n , the center of ventilation increased compared to\n SB<\/jats:styled-content>\n \u20101 (\n p<\/jats:italic>\n \u2009=\u20090.001),\n SB<\/jats:styled-content>\n \u20102 (\n p<\/jats:italic>\n \u2009=\u20090.004), and\n CPAP<\/jats:styled-content>\n (\n p\u2009=<\/jats:italic>\n \u20090.004), suggesting that ventilation was shifted toward the ventral areas of the lungs. On the other hand,\n CPAP<\/jats:styled-content>\n was not effective in restoring\n RVD40<\/jats:styled-content>\n ,\n GI<\/jats:styled-content>\n , and\n EELI<\/jats:styled-content>\n to\n SB1<\/jats:styled-content>\n values following the induction of intravenous anesthesia with propofol at\n SB<\/jats:styled-content>\n \u20102.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n In this specific ventilatory setting, spontaneous breathing sedation resulted in enhanced ventilation inhomogeneity and a reduction in\n EELI<\/jats:styled-content>\n that could be reversed by\n NIV<\/jats:styled-content>\n but not by\n CPAP<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trials Registration<\/jats:title>\n \n The trial was registered prior to patient enrollment at\n Clinicaltrials.gov<\/jats:ext-link>\n (NCT05495477; principal investigator: Giovanna Chidini; date of registration: August 10, 2022). Consolidated Standards of Reporting Trials guidelines were followed, and the study was conducted according to the Helsinki 1964 Ethical Declaration Standard, revised in 2008.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/pan.15098","type":"journal-article","created":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T11:24:00Z","timestamp":1742729040000},"page":"562-572","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Effects of Noninvasive Respiratory Support on Ventilation Distribution During Spontaneous Breathing Sedation in Preschool\/School\u2010Aged Children: An Electrical Impedance Tomography Study"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3807-1184","authenticated-orcid":false,"given":"Giovanna","family":"Chidini","sequence":"first","affiliation":[{"name":"Pediatric Intensive Care Unit, Department of Anesthesia, Critical Care and Emergency Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziana","family":"Marchesi","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Department of Anesthesia, Critical Care and Emergency Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano Scalia","family":"Catenacci","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Department of Anesthesia, Critical Care and Emergency Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Florio","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation University of Milan Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Conti","sequence":"additional","affiliation":[{"name":"Institute of Anesthesia and Intensive Care Catholic University of Sacred Heart Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Lanni","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Filocamo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Patria","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Guerrini","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, Department of Anesthesia, Critical Care and Emergency Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregorio","family":"Milani","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Grasselli","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation University of Milan Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,22]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aew173"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2019.01.036"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/66.4.423"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2021.110626"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0000000000001351"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2006.02045.x"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40981-019-0297-z"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.33029"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2016-208357"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e318256ee08"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2011.03547.x"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1088\/0967-3334\/28\/7\/S18"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2016.04.016"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-023-02079-z"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03540080059030"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.4103\/0022-3859.52846"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-009-1589-y"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-540-92276-6_39"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.09190"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc8860"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ANE.0000184115.57837.30"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.108.4.1059"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0283039"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.1950030506"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13613\u2010016\u20100113\u20100"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.15098","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T01:05:12Z","timestamp":1749517512000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pan.15098"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,22]]},"references-count":25,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1111\/pan.15098"],"URL":"https:\/\/doi.org\/10.1111\/pan.15098","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"value":"1155-5645","type":"print"},{"value":"1460-9592","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,22]]},"assertion":[{"value":"2024-07-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}