Effect of Heat and Moisture Exchange Filter on the Dead Space Ventilation in a Pediatric Patient

The use of heat and moisture exchange filter (HMEF) has become a routine standard of care in general anesthesia (GA), more so, during the current COVID-19 pandemic times. However its routine use, especially in pediatric patients, has several issues. We report a case of increased dead space ventilation in a pediatric patient due to the presence of HMEF. Hypercapnia and its cause was instantly diagnosed with two capnography sampling lines placed at two ends of the HMEF.

Assessment of Ventilation and Perfusion in Patients with COVID-19 Discloses Unique Information of Pulmonary Function to a Clinician: Case Reports of V/P SPECT

V/P SPECT from 4 consecutive patients with COVID-19 suggests that ventilation and perfusion images may be applied to diagnose or exclude pulmonary embolism, verify nonsegmental diversion of perfusion from the ventilated areas (dead space ventilation) that may represent inflammation of the pulmonary vasculature, detect the reversed mismatch of poor ventilation and better preserved perfusion (shunt perfusion) in bilateral pulmonary inflammation and indicate redistribution of lung perfusion (antigravitational hyperperfusion) due to cardiac congestion. V/P mismatch and reversed mismatch may be extensive enough to diminish dramatically preserved matching ventilation/perfusion and to induce severe hypoxemia in COVID-19.

Advanced Respiratory Monitoring in COVID-19 Patients: Use Less PEEP!

With the emergence of COVID-19 we are confronted with a new clinical picture of acute respiratory distress syndrome in the intensive care unit. In the majority of patients, the respiratory mechanics are very different from the “normal” ARDS patient. We measured transpulmonary pressure and dead space ventilation to assess the effects of high and low PEEP levels on lung compliance and ventilation-perfusion mismatching. Advanced respiratory mechanics were assessed in 14 patients. Compared to ARDS patients, lung compliance was relatively high (61 ± 5 mL/cmH2O). COVID-19 patients had high dead space ventilation and gas exchange impairment (Bohr 52 ± 3%; Enghoff modification 67 ± 2%; ventilatory ratio 2.24 ± 0.23). we show that higher PEEP levels decrease lung compliance and in most cases increase dead space ventilation, indicating that high PEEP levels probably cause hyperinflation in patients with COVID-19. We suggest using prone position for an extended period of time, and apply lower PEEP levels as much as possible.