scholarly journals The Effect of Positive End Expiratory Pressure on Rebreathing and Gas Dilution in the Ayre's T-Piece System—A Laboratory Study

1978 ◽  
Vol 6 (1) ◽  
pp. 19-25 ◽  
Author(s):  
T. L. Dobbinson ◽  
E. R. Fawcett ◽  
D. P. G. Bolton
Keyword(s):  
Spontaneous Breathing ◽  
Gas Flow ◽  
Minute Volume ◽  
Lung Model ◽  
Positive End Expiratory Pressure ◽  
System A ◽  
Test Conditions ◽  
Controlled Breathing ◽  
Gas Dilution ◽  
End Tidal

The effect of positive end expiratory pressure on the function of the Ayre's T-Piece System was studied using a simple lung model. Positive end expiratory pressure did not affect end tidal CO 2 during “controlled breathing” but caused an increase during “spontaneous breathing” when fresh gas flow was less than 3 times the minute volume. Gas dilution did not occur under any of the test conditions.

scholarly journals Wash-in and wash-out of sevoflurane in a test-lung model: A comparison between Aisys and FLOW-i

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 389 ◽  
Author(s):  
Petter Jakobsson ◽  
Madleine Lindgren ◽  
Jan G. Jakobsson
Keyword(s):  
Gas Flow ◽  
Anaesthetic Machine ◽  
Flow Time ◽  
Lung Model ◽  
Low Flow ◽  
Major Influence ◽  
Test Lung ◽  
Depth Of Anaesthesia ◽  
Low Flow Anaesthesia ◽  
End Tidal

Background:Modern anaesthesia workstations are reassuringly tight and are equipped with effective gas monitoring, thus providing good opportunities for low/minimal flow anaesthesia. A prerequisite for effective low flow anaesthesia is the possibility to rapidly increase and decrease gas concentrations in the circle system, thereby controlling the depth of anaesthesia. Methods:We studied the wash-in and wash-out of sevoflurane in the circle system with fixed fresh gas flow and vaporizer setting. We compared two modern anaesthesia work stations, the Aisys (GE, Madison, WI, USA) and FLOW-i (Maquet, Solna, Sweden) in a test lung model. Results: We found fresh-gas flow to have, as expected, a major influence on wash-in, as well as wash-out of sevoflurane. The wash-in time to reach a stable circle 1 MAC (2.1%) decreased from an average of 547 ± 83 seconds with a constant fresh gas flow of 300 ml/min and vaporizer setting of 8%, to a mean of 38 ± 6 seconds at a fresh gas flow of 4 L/min. There were only minor differences between the two works-stations tested; the Aisys was slightly faster at both 300 and 4 L/min flow. Time to further increase circle end-tidal concentration from 1-1.5 MAC showed likewise significant associations to fresh gas and decreased from 330 ± 24 seconds at 300 ml/min. to less than a minute at constant 4 L/min (17 ± 11 seconds), without anaesthetic machine difference. Wash-out was also fresh gas flow dependent and plateaued at 7.5 L/min. Conclusions: Circle system wash-in and wash-out show clear fresh gas dependency and varies somewhat between the Aisys and Flow-i. The circle saturation, reaching 1 MAC end-tidal or increasing from 1-1.5 MAC can be achieved with both work-stations within 1.5 minutes at a constant fresh gas flow of 2 and 4 L/min. Wash-out plateaued at 7.5 L/min.

scholarly journals VENTILAÇÃO CONTROLADA COM PRESSÃO EXPIRATÓRIA FINAL POSITIVA EM SUÍNOS ANESTESIADOS COM ISOFLURANO OU HALOTANO E SUBMETIDOS A PNEUMOPERITÔNIO OU PNEUMOTÓRAX COM CO2

2002 ◽  
Vol 7 (2) ◽  
Author(s):  
A. F. CUNHA ◽  
C. C. NATALINI ◽  
S. D. L ALVES ◽  
S. BOPP ◽  
J. F. FERREIRA ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Intrathoracic Pressure ◽  
Minute Volume ◽  
Abdominal Pressure ◽  
Positive End Expiratory Pressure ◽  
Controlled Ventilation ◽  
End Tidal Carbon Dioxide ◽  
Peep Ventilation ◽  
End Tidal ◽  
Mean Heart Rate

A homeostase hemodinâmica e respiratória nas vídeo cirurgias onde se emprega insuflação abdominal ou torácica requer métodos especiais de ventilação como a pressão expiratória final positiva (PEEP). Este experimento teve por objetivo avaliar a hemodinâmica e a oxigenação de suínos submetidos anestesia geral com isoflurano ou halotano onde foi realizado pneumoperitôneo a uma pressão constante de 15 mmHg ou pneumotórax de 5 mmHg com CO2 e ventilados com pressão expiratória zero ou 10 cm de H2O. Foram estudadas as variáveis pressão arterial (sistólica, média e diastólica), freqüência cardíaca e respiratória, saturação de oxigênio na hemoglobina (SpO2), volume corrente e minuto, eletrocardiografia e ainda pressão parcial de dióxido de carbono expirado. Onde foram observados valores de SpO2 mais elevados nos grupos submetidos a PEEP e maior hipotensão nos suínos anestesiados com halotano, nos permitindo concluir que quando comparado com o grupo que recebeu pressão expiratória final zero o uso de 10 cm de água de PEEP melhora a SpO2 e o isoflurano é superior ao halotano na manutenção da função cardiovascular de suínos submetidos à insuflação intra-abdominal ou intratorácica com CO2. Controlled ventilation with Positive End-Expiratory Pressure in isoflurane or halotane anesthetized pigs submitted to pneumoperitoneum or pneumothorax with CO2 Abstract Hemodynamic and respiratory homeostasy in the video surgeries need special ventilatory methods as positive end-expiratory pressure (PEEP). This study aimed to investigate the hemodynamic and oxygenation effects in isoflurane or halotane anesthetized pigs, submitted to constant 15 mm Hg CO2 abdominal pressure or 5 mm Hg CO2 intrathoracic pressure of 10 cm of H2O of PEEP or 0 cm of H2O (ZEEP). Variables studied were arterial pressure (systolic, diastolic and mean) heart rate, respiratory rate, SpO2, tidal volume, minute volume, electrocardiogram and expiratory end-tidal carbon dioxide. Were observed improved in SpO2 with 10 cm of H2O PEEP and more hypotension in the halotane anesthetized group. We conclude that when compared to ZEEP group, 10 cm of H2O PEEP ventilation improves SPO2, while isoflurane is better to maintain the cardiovascular function to anesthetized pigs submitted to 15 mm Hg intra-abdominal and 5 mm Hg intratoracic pressure insufflations with CO2.

scholarly journals Large variations of oxygen delivery in self-inflating resuscitation bags used for preoxygenation - a mechanical simulation

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Sven Grauman ◽  
Joakim Johansson ◽  
Thomas Drevhammar
Keyword(s):  
Airway Management ◽  
Oxygen Delivery ◽  
Spontaneous Breathing ◽  
Gas Flow ◽  
Minute Volume ◽  
Minute Period ◽  
Common Notion ◽  
High Fraction ◽  
Emergency Anaesthesia

Abstract Background Self-Inflating Resuscitation Bags (SIRB) are common and essential tools in airway management and ventilation. They are often used in resuscitation and emergency anaesthesia outside the operating theatre. There is a common notion that all SIRBs applied with a tight sealed mask will deliver close to 100 % oxygen during spontaneous breathing. The aim of the study was to measure the oxygen delivery of six commonly used SIRBs in a mechanical spontaneous breathing adult in vitro model. Methods Three SIRBs of each of the six models were evaluated for oxygen delivery during simulated breathing with an adult mechanical lung. The test was repeated three times per device (54 tests in total). The breathing profile was fixed to a minute volume of 10 L/min, a tidal volume of 500 mL and the SIRBs supplied with an oxygen fresh gas flow of 15 L/min. The fraction of delivered oxygen (FDO2) was measured over a three-minute period. Average FDO2 was calculated and compared at 30, 60 and 90 s. Results At 90 s all models had reached a stable FDO2. Average FDO2 at 90 s; Ambu Oval Plus 99,5 %; Ambu Spur II 99,8 %; Intersurgical BVM Resuscitator 76,7 %; Laerdal Silicone 97,3 %; Laerdal The Bag II 94,5 % and the O-Two Smart Bag 39,0 %. All differences in FDO2 were significant apart from the two Ambu models. Conclusions In simulated spontaneous breathing, four out of six (by Ambu and Laerdal) Self-Inflating Resuscitation Bags delivered a high fraction of oxygen while two (Intersurgical and O-two) underperformed in oxygen delivery. These large variations confirm results reported in other studies. It is our opinion that underperforming Self-Inflating Resuscitation Bags might pose a serious threat to patients’ health if used in resuscitation and anaesthesia. Manufacturers of Self-Inflating Resuscitation Bags rarely provide information on performance for spontaneous breathing. This poses a challenge to all organizations that need their devices to deliver adequate oxygen during spontaneous breathing.

scholarly journals Wash-in and wash-out of sevoflurane in a test-lung model: A comparison between Aisys and FLOW-i

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 389 ◽  
Author(s):  
Petter Jakobsson ◽  
Madleine Lindgren ◽  
Jan G. Jakobsson
Keyword(s):  
Gas Flow ◽  
Anaesthetic Machine ◽  
Flow Time ◽  
Lung Model ◽  
Low Flow ◽  
Major Influence ◽  
Test Lung ◽  
Depth Of Anaesthesia ◽  
Low Flow Anaesthesia ◽  
End Tidal

Background:Modern anaesthesia workstations are reassuringly tight and are equipped with effective gas monitoring, thus providing good opportunities for low/minimal flow anaesthesia. A prerequisite for effective low flow anaesthesia is the possibility to rapidly increase and decrease gas concentrations in the circle system, thereby controlling the depth of anaesthesia. Methods:We studied the wash-in and wash-out of sevoflurane in the circle system with fixed fresh gas flow and vaporizer setting. We compared two modern anaesthesia work stations, the Aisys (GE, Madison, WI, USA) and FLOW-i (Maquet, Solna, Sweden) in a test lung model. Results: We found fresh-gas flow to have, as expected, a major influence on wash-in, as well as wash-out of sevoflurane. The wash-in time to reach a stable circle 1 MAC (2.1%) decreased from an average of 547 ± 83 seconds with a constant fresh gas flow of 300 ml/min and vaporizer setting of 8%, to a mean of 38 ± 6 seconds at a fresh gas flow of 4 L/min. There were only minor differences between the two works-stations tested; the Aisys was slightly faster at both 300 and 4 L/min flow. Time to further increase circle end-tidal concentration from 1-1.5 MAC showed likewise significant associations to fresh gas and decreased from 330 ± 24 seconds at 300 ml/L to less than a minute at constant 4 L/min (17 ± 11 seconds), without anaesthetic machine difference. Wash-out was also fresh gas flow dependent and plateaued at 7.5 L/min. Conclusions: Circle system wash-in and wash-out show clear fresh gas dependency and varies somewhat between the Aisys and Flow-i. The circle saturation, reaching 1 MAC end-tidal or increasing from 1-1.5 MAC can be achieved with both work-stations within 1.5 minutes at a constant fresh gas flow of 2 and 4 L/min. Wash-out plateaued at 7.5 L/min.

scholarly journals Low Spontaneous Breathing Effort during Extracorporeal Membrane Oxygenation in a Porcine Model of Severe Acute Respiratory Distress Syndrome

2020 ◽  
Vol 133 (5) ◽  
pp. 1106-1117
Author(s):  
Sebastián Dubo ◽  
Vanesa Oviedo ◽  
Alinee Garcia ◽  
Leyla Alegría ◽  
Patricio García ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Lung Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Spontaneous Breathing ◽  
Gas Flow ◽  
Pressure Support ◽  
Distress Syndrome ◽  
Positive End Expiratory Pressure ◽  
Membrane Oxygenation ◽  
Breathing Effort

Background A lung rest strategy is recommended during extracorporeal membrane oxygenation in severe acute respiratory distress syndrome (ARDS). However, spontaneous breathing modes are frequently used in this context. The impact of this approach may depend on the intensity of breathing efforts. The authors aimed to determine whether a low spontaneous breathing effort strategy increases lung injury, compared to a controlled near-apneic ventilation, in a porcine severe ARDS model assisted by extracorporeal membrane oxygenation. Methods Twelve female pigs were subjected to lung injury by repeated lavages, followed by 2-h injurious ventilation. Thereafter, animals were connected to venovenous extracorporeal membrane oxygenation and during the first 3 h, ventilated with near-apneic ventilation (positive end-expiratory pressure, 10 cm H2O; driving pressure, 10 cm H2O; respiratory rate, 5/min). Then, animals were allocated into (1) near-apneic ventilation, which continued with the previous ventilatory settings; and (2) spontaneous breathing: neuromuscular blockers were stopped, sweep gas flow was decreased until regaining spontaneous efforts, and ventilation was switched to pressure support mode (pressure support, 10 cm H2O; positive end-expiratory pressure, 10 cm H2O). In both groups, sweep gas flow was adjusted to keep Paco2 between 30 and 50 mmHg. Respiratory and hemodynamic as well as electric impedance tomography data were collected. After 24 h, animals were euthanized and lungs extracted for histologic tissue analysis. Results Compared to near-apneic group, the spontaneous breathing group exhibited a higher respiratory rate (52 ± 17 vs. 5 ± 0 breaths/min; mean difference, 47; 95% CI, 34 to 59; P < 0.001), but similar tidal volume (2.3 ± 0.8 vs. 2.8 ± 0.4 ml/kg; mean difference, 0.6; 95% CI, –0.4 to 1.4; P = 0.983). Extracorporeal membrane oxygenation settings and gas exchange were similar between groups. Dorsal ventilation was higher in the spontaneous breathing group. No differences were observed regarding histologic lung injury. Conclusions In an animal model of severe ARDS supported with extracorporeal membrane oxygenation, spontaneous breathing characterized by low-intensity efforts, high respiratory rates, and very low tidal volumes did not result in increased lung injury compared to controlled near-apneic ventilation. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Importance of ventilation in modulating interaction between sympathetic drive and cardiovascular variability

2001 ◽  
Vol 280 (2) ◽  
pp. H722-H729 ◽  
Author(s):  
Philippe Van De Borne ◽  
Nicola Montano ◽  
Krzysztof Narkiewicz ◽  
Jean P. Degaute ◽  
Alberto Malliani ◽  
...  
Keyword(s):  
Sympathetic Nerve ◽  
Sympathetic Nerve Activity ◽  
Muscle Sympathetic Nerve Activity ◽  
Minute Ventilation ◽  
Low Frequency ◽  
Nerve Activity ◽  
Cardiovascular Variability ◽  
Controlled Breathing ◽  
End Tidal ◽  
Cardiovascular Rhythms

Chemoreflex stimulation elicits both hyperventilation and sympathetic activation, each of which may have different influences on oscillatory characteristics of cardiovascular variability. We examined the influence of hyperventilation on the interactions between changes in R-R interval (RR) and muscle sympathetic nerve activity (MSNA) and changes in neurocirculatory variability, in 14 healthy subjects. We performed spectral analysis of RR and MSNA variability during each of the following interventions: 1) controlled breathing, 2) maximal end-expiratory apnea, 3) isocapnic voluntary hyperventilation, and 4) hypercapnia-induced hyperventilation. MSNA increased from 100% during controlled breathing to 170 ± 25% during apnea ( P = 0.02). RR was unchanged, but normalized low-frequency (LF) variability of both RR and MSNA increased markedly ( P < 0.001). During isocapnic hyperventilation, minute ventilation increased to 20.2 ± 1.4 l/min ( P < 0.0001). During hypercapnic hyperventilation, minute ventilation also increased (to 19.7 ± 1.7 l/min) as did end-tidal CO2 (both P < 0.0001). MSNA remained unchanged during isocapnic hyperventilation (104 ± 7%) but increased to 241 ± 49% during hypercapnic hyperventilation ( P < 0.01). RR decreased during both isocapnic and hypercapnic hyperventilation ( P < 0.05). However, normalized LF variability of RR and of MSNA decreased ( P < 0.05) during both isocapnic and hypercapnic hyperventilation, despite the tachycardia and heightened sympathetic nerve traffic. In conclusion, marked respiratory oscillations in autonomic drive induced by hyperventilation may induce dissociation between RR, MSNA, and neurocirculatory variability, perhaps by suppressing central genesis and/or inhibiting transmission of LF cardiovascular rhythms.

Effects of the Water Content of Soda Lime on Compound A Concentration in the Anesthesia Circuit in Sevoflurane Anesthesia 

1998 ◽  
Vol 88 (1) ◽  
pp. 66-71 ◽  
Author(s):  
Hiromichi Bito ◽  
Yukako Ikeuchi ◽  
Kazuyuki Ikeda
Keyword(s):  
Gas Flow ◽  
Soda Lime ◽  
Absorption Capacity ◽  
Low Flow ◽  
Co2 Absorption ◽  
Sevoflurane Anesthesia ◽  
Compound A ◽  
Carbon Dioxide Co2 ◽  
End Tidal ◽  
Co2 Elimination

Background Sevoflurane anesthesia is usually performed with fresh gas flow rates greater than 2 l/min due to the toxicity of compound A in rats and limited clinical experience with sevoflurane in low-flow systems. However, to reduce costs, it would be useful to identify ways to reduce compound A concentrations in low-flow sevoflurane anesthesia. This goal of this study was to determine if compound A concentrations can be reduced by using soda lime with water added. Methods Low-flow sevoflurane anesthesia (fresh gas flow of 1 l/min) was performed in 37 patients using soda lime with water added (perhydrated soda lime) or standard soda lime as the carbon dioxide (CO2) absorbent. The soda lime was not changed between patients, but rather was used until CO2 rebreathing occurred. The perhydrated soda lime was prepared by spraying 100 ml distilled water onto 1 kg fresh soda lime, and water was added only when a new bag of soda lime was placed into the canister. Compound A concentrations in the circle system, soda lime temperatures, inspired and end-tidal CO2 and end-tidal sevoflurane concentrations, and CO2 elimination by the patient were measured during anesthesia. Results Compound A concentrations were significantly lower for the perhydrated soda lime (1.9 +/- 1.8 ppm; means +/- SD) than for the standard soda lime (13.9 +/- 8.2 ppm). No differences were seen between the two types of soda lime with regard to the temperature of the soda lime, end-tidal sevoflurane concentrations, or CO2 elimination. Compound A concentration decreased with the total time of soda lime use for both types of soda lime. The CO2 absorption capacity was significantly less for perhydrated soda lime than for standard soda lime. Conclusions Compound A concentrations in the circuit can be reduced by using soda lime with water added. The CO2 absorption capacity of the soda lime is reduced by adding water to it, but this should not be clinically significant.

Effect of Fresh Gas Flow on Isoflurane Concentrations during Low-flow Anaesthesia

2005 ◽  
Vol 33 (5) ◽  
pp. 513-519 ◽  
Author(s):  
J-Y Park ◽  
J-H Kim ◽  
W-Y Kim ◽  
M-S Chang ◽  
J-Y Kim ◽  
...  
Keyword(s):  
Gas Flow ◽  
Low Flow ◽  
Physical Status ◽  
Closed Circle ◽  
Haemodynamic Changes ◽  
Low Flow Anaesthesia ◽  
Baseline Values ◽  
American Society ◽  
End Tidal ◽  
Closed Circle System

The effect of fresh gas flow (FGF) on isoflurane concentrations at given vaporizer settings during low-flow anaesthesia was investigated. Ninety patients (American Society of Anaesthesiologists physical status I or II) were randomly allocated to three groups (FGF 1 l/min, FGF 2 l/min and FGF 4 l/min). Anaesthesia was maintained for 10 min with vaporizer setting isoflurane 2 vol% and FGF 4 l/min for full-tissue anaesthetic uptake in a semi-closed circle system. Low-flow anaesthesia was maintained for 20 min with end-tidal isoflurane 1.5 vol% and FGF 2 l/min. FGF was then changed to FGF 1 l/min, FGF 2 l/min or FGF 4 l/min. Measurements during the 20-min period showed that inspired and end-tidal isoflurane concentrations decreased in the FGF 1-l/min group but increased in the FGF 4-l/min group compared with baseline values. No haemodynamic changes were observed. Monitoring of anaesthetic concentrations and appropriate control of vaporizer settings are necessary during low-flow anaesthesia.

scholarly journals Heart rate variability and muscle sympathetic nerve activity response to acute stress: the effect of breathing

2010 ◽  
Vol 299 (1) ◽  
pp. R80-R91 ◽  
Author(s):  
Lindsay D. DeBeck ◽  
Stewart R. Petersen ◽  
Kelvin E. Jones ◽  
Michael K. Stickland
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Sympathetic Nerve ◽  
Spontaneous Breathing ◽  
Sympathetic Nerve Activity ◽  
Muscle Sympathetic Nerve Activity ◽  
Cold Pressor ◽  
Isometric Handgrip ◽  
Nerve Activity ◽  
Controlled Breathing

Previous research has suggested a relationship between low-frequency power of heart rate variability (HRV; LF in normalized units, LFnu) and muscle sympathetic nerve activity (MSNA). However, investigations have not systematically controlled for breathing, which can modulate both HRV and MSNA. Accordingly, the aims of this experiment were to investigate the possibility of parallel responses in MSNA and HRV (LFnu) to selected acute stressors and the effect of controlled breathing. After data were obtained at rest, 12 healthy males (28 ± 5 yr) performed isometric handgrip exercise (30% maximal voluntary contraction) and the cold pressor test in random order, and were then exposed to hypoxia (inspired fraction of O2 = 0.105) for 7 min, during randomly assigned spontaneous and controlled breathing conditions (20 breaths/min, constant tidal volume, isocapnic). MSNA was recorded from the peroneal nerve, whereas HRV was calculated from ECG. At rest, controlled breathing did not alter MSNA but decreased LFnu ( P < 0.05 for all) relative to spontaneous breathing. MSNA increased in response to all stressors regardless of breathing. LFnu increased with exercise during both breathing conditions. During cold pressor, LFnu decreased when breathing was spontaneous, whereas in the controlled breathing condition, LFnu was unchanged from baseline. Hypoxia elicited increases in LFnu when breathing was controlled, but not during spontaneous breathing. The parallel changes observed during exercise and controlled breathing during hypoxia suggest that LFnu may be an indication of sympathetic outflow in select conditions. However, since MSNA and LFnu did not change in parallel with all stressors, a cautious approach to the use of LFnu as a marker of sympathetic activity is warranted.

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