L.W. Sturesson, G. Malmkvist, M. Bodelsson, L. Niklason, B. Jonson

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Presentation transcript:

Carbon dioxide rebreathing with the anaesthetic conserving device, AnaConDa® L.W. Sturesson, G. Malmkvist, M. Bodelsson, L. Niklason, B. Jonson British Journal of Anaesthesia Volume 109, Issue 2, Pages 279-283 (August 2012) DOI: 10.1093/bja/aes102 Copyright © 2012 The Author(s) Terms and Conditions

Fig 1 Experimental set-up consisted of a ServoVentilator 900C (A), tubes to a Y-piece (B), a CO2 transducer on the ventilator side (CO2vent, C), an HME/ACD (D), a CO2 transducer on the lung side (CO2lung, E), a connection tube to the experimental lung (F) and an experimental lung (G). CO2 from a bottle (H) was fed through a rotameter (I), to the test lung. Signals for flow from the ventilator (J) and CO2 signals from both CO2 analysers (K) were fed to a computer (L) and displayed on a screen (M). British Journal of Anaesthesia 2012 109, 279-283DOI: (10.1093/bja/aes102) Copyright © 2012 The Author(s) Terms and Conditions

Fig 2 The single-breath test for CO2 displays expired tidal volume on the x-axis and CO2 fraction (%) on the y-axis. During expiration, CO2-free airway gas is expired first, followed by mixed airway and alveolar gas, and finally alveolar gas (alveolar plateau). Initially, during inspiration, CO2-containing gas from the Y-piece and ventilator tubing is re-inspired. The volume of re-inspired CO2 (VICO2) is represented by the green hatched area. The blue area represents the volume of CO2 eliminated during the breathing cycle (VTCO2). The volume of CO2 expired during the breath corresponds to blue plus green shaded areas (VTCO2+VICO2). End-tidal CO2 (E′CO2) is indicated by the horizontal arrow and the airway dead space (VDaw) by the vertical arrow. British Journal of Anaesthesia 2012 109, 279-283DOI: (10.1093/bja/aes102) Copyright © 2012 The Author(s) Terms and Conditions

Fig 3 End-tidal CO2 (E′CO2) measured at the ventilator CO2 transducer using an HME, inactive ACD, or active ACD (upper curve). Tidal volume was increased by 50 ml corresponding to the difference in the internal volume between the HME and ACD when the inactive ACD was introduced (lower region). With the active ACD, when E′CO2 approached 10%, VT was increased stepwise in order to restore the original value of E′CO2. British Journal of Anaesthesia 2012 109, 279-283DOI: (10.1093/bja/aes102) Copyright © 2012 The Author(s) Terms and Conditions

Fig 4 Single-breath tests for CO2 (SBT-CO2) with an HME (a and b) or active ACD (c and d) registered on the ventilator (a and c) or lung (b and d) side of the device, respectively. The volumes of CO2 eliminated during the breath (VTCO2, blue area) and inspired (VICO2, green shaded area) are indicated. Apparent airway dead space (VDaw) is indicated by the vertical arrow. SBT-CO2 was studied after adjustment of tidal volume to maintain isocapnia and in steady state with respect to CO2 elimination. As illustrated in (c), the effect of the ACD is analogous to a large increase in VDaw observed on the ventilator side of the device. In (d), this is reflected by the green shaded area, representing a large volume of re-inspired CO2 from the ACD. British Journal of Anaesthesia 2012 109, 279-283DOI: (10.1093/bja/aes102) Copyright © 2012 The Author(s) Terms and Conditions

Fig 5 Amount of CO2 eliminated from the active ACD at different CO2 fractions. British Journal of Anaesthesia 2012 109, 279-283DOI: (10.1093/bja/aes102) Copyright © 2012 The Author(s) Terms and Conditions