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

Slides:



Advertisements
Similar presentations
D.H.T. Scott, G.B. Drummond  British Journal of Anaesthesia 
Advertisements

F. Chung, R. Subramanyam, P. Liao, E. Sasaki, C. Shapiro, Y. Sun 
Relationship of inspiratory and expiratory times to upper airway resistance during pulsatile needle cricothyrotomy ventilation with generic delivery circuit 
S. Schumann, C.A. Stahl, K. Möller, H.-J. Priebe, J. Guttmann 
Increasing positive end-expiratory pressure (re-)improves intraoperative respiratory mechanics and lung ventilation after prone positioning  J Spaeth,
Ventilation with low tidal volumes during upper abdominal surgery does not improve postoperative lung function  T.A. Treschan, W. Kaisers, M.S. Schaefer,
C. Unzueta, G. Tusman, F. Suarez-Sipmann, S. Böhm, V. Moral 
Acute respiratory and metabolic acidosis induced by excessive muscle contraction during spinal evoked stimulation  Y Tohdoh, S Sumita, T Kawamata, K Omote,
SponTaneous Respiration using IntraVEnous anaesthesia and Hi-flow nasal oxygen (STRIVE Hi) maintains oxygenation and airway patency during management.
Patient–ventilator interaction
Intravenous boluses of fentanyl, 1 µg kg−1, and remifentanil, 0
K.L. Dorrington, W. Poole  British Journal of Anaesthesia 
Effects of airway occlusion on breathing muscle electromyogram signals, during isoflurane anaesthesia, with and without the effects of fentanyl and hypercapnia 
AnestAssist British Journal of Anaesthesia
Forty years of closing volume
The effect of bi-level positive airway pressure mechanical ventilation on gas exchange during general anaesthesia  Yu G , Yang K , Baker A.B. , Young.
Double-lumen tubes and auto-PEEP during one-lung ventilation
Lidocaine use in ultrasound-guided femoral nerve block: what is the minimum effective anaesthetic concentration (MEAC90)?†  A.M. Taha, A.M. Abd-Elmaksoud 
Static versus dynamic respiratory mechanics for setting the ventilator
Anaesthetic conserving device AnaConDa®: dead space effect and significance for lung protective ventilation  L.W. Sturesson, M. Bodelsson, B. Jonson,
‘Failed supraglottic airway’: an algorithm for suboptimally placed supraglottic airway devices based on videolaryngoscopy  A.A.J. Van Zundert, S.P. Gatt,
A different use of visual analytic techniques in anaesthetics
Fresh gas flow is not the only determinant of volatile agent consumption: a multi-centre study of low-flow anaesthesia†   J.F. Coetzee, L.J. Stewart 
Measurement of functional residual capacity by modified multiple breath nitrogen washout for spontaneously breathing and mechanically ventilated patients 
Perioperative assessment of regional ventilation during changing body positions and ventilation conditions by electrical impedance tomography  A. Ukere,
Capnogram slope and ventilation dead space parameters: comparison of mainstream and sidestream techniques  A.L. Balogh, F. Petak, G.H. Fodor, J. Tolnai,
Efficacy of a new dual channel laryngeal mask airway, the LMA®Gastro™ Airway, for upper gastrointestinal endoscopy: a prospective observational study 
Preoxygenation: a comparison of three different breathing systems
Practical assessment of respiratory mechanics
Delivery of tidal volume from four anaesthesia ventilators during volume-controlled ventilation: a bench study†  G. Wallon, A. Bonnet, C. Guérin  British.
H. Reissmann, W. Pothmann, B. Füllekrug, R. Dietz, J. Schulte am Esch 
J.A. Short, S.T. Paris, P.D. Booker, R Fletcher 
U. Goebel, J. Haberstroh, K. Foerster, C. Dassow, H. -J. Priebe, J
L.M. Ferguson, G.B. Drummond  British Journal of Anaesthesia 
Effects of alveolar dead-space, shunt and V ˙ / Q ˙ distribution on respiratory dead- space measurements  Y. Tang, M.J. Turner, A.B. Baker  British Journal.
Protective ventilation in experimental acute respiratory distress syndrome after ventilator-induced lung injury: a randomized controlled trial  L. Uttman,
Raised serum cardiac troponin I concentrations predict hospital mortality in intensive care unit patients†  T. Reynolds, M. Cecconi, P. Collinson, A.
Editorial II: Deadspace: invasive or not?
Correction to the paper ‘Delivery of tidal volume from four anaesthesia ventilators during volume-controlled ventilation: a bench study’  M Hallbäck,
Does regional anaesthesia improve outcome after total hip arthroplasty
Continuous spinal anaesthesia and non-invasive ventilation for total knee replacement in a patient on home ventilation  J. Dawson, M. Jones, N. Hirschauer,
Do team processes really have an effect on clinical performance
New ventilators for the ICU—usefulness of lung performance reporting
A national survey of the impact of NAP4 on airway management practice in United Kingdom hospitals: closing the safety gap in anaesthesia, intensive care.
Transcontinental anaesthesia: a pilot study
Ultrasound-assisted spinal anaesthesia in a patient with Wildervanck syndrome and congenital abnormalities of the lumbar spine  T. Schisler, H. Huttunen,
Systemic recirculation assessed in apnoeic anaesthetized patients using carbon dioxide concentration measurements during stepwise expiration  F. Pizzichetta,
B. Pearce, G.B. Drummond  British Journal of Anaesthesia 
Non-invasive metabolic monitoring of patients under anaesthesia by continuous indirect calorimetry—an in vivo trial of a new method  C. Stuart-Andrews,
Wash-in kinetics for sevoflurane using a disposable delivery system (AnaConDa®) in cardiac surgery patients  L.W. Sturesson, A. Johansson, M. Bodelsson,
Distraction and interruption in anaesthetic practice
Do old pharmacokinetic parameter estimates predict new data?
Ventilation strategies in obese patients undergoing surgery: a quantitative systematic review and meta-analysis†  M. Aldenkortt, C. Lysakowski, N. Elia,
An appropriate inspiratory flow pattern can enhance CO2 exchange, facilitating protective ventilation of healthy lungs  L.W. Sturesson, G. Malmkvist,
Direct measurement of nitrous oxide kinetics†
Jet or intensive care unit ventilator during simulated percutaneous transtracheal ventilation: a lung model study  Y.H. Liu, A.L. Wang, A.D. Marchese,
Pumpless arterio-venous extracorporeal lung assist compared with veno-venous extracorporeal membrane oxygenation during experimental lung injury  R. Kopp,
Pressure-controlled ventilation improves oxygenation during laparoscopic obesity surgery compared with volume-controlled ventilation  P. Cadi, T. Guenoun,
Titration of electroconvulsive therapy: the use of rocuronium and sugammadex with adjunctive laryngeal mask  T.K.F. Chow  British Journal of Anaesthesia 
Predictive value of pulse pressure variation for fluid responsiveness in septic patients using lung-protective ventilation strategies  F.G.R. Freitas,
Corrigendum British Journal of Anaesthesia
H Rozé, M Lafargue, H Batoz, M. Q
Optimizing cerebral oxygenation in anaesthetized patients with carotid artery stenosis: the influence of inspired oxygen fraction  P. Picton, S.K. Ramachandran,
Detection of optimal PEEP for equal distribution of tidal volume by volumetric capnography and electrical impedance tomography during decreasing levels.
Individual patient data analysis of tidal volumes used in three large randomized control trials involving patients with acute respiratory distress syndrome 
Teamwork, communication, and anaesthetic assistance in Scotland
J.H. Philip  British Journal of Anaesthesia 
Lung isolation in the morbidly obese patient: a comparison of a left-sided double-lumen tracheal tube with the Arndt® wire-guided blocker  J.H. Campos,
Influence of head and neck position on ventilation using the air-Q® SP airway in anaesthetized paralysed patients: a prospective randomized crossover.
S. Singaravelu, P. Barclay  British Journal of Anaesthesia 
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