Dead-space washout by split-flow ventilation. A new method to reduce ventilation needs in premature infants

Wald, Martin; Kalous, P; Lawrenz, Karin; Jeitler, Valerie; Weninger, M.; Kirchner, Lieselotte

doi:10.1007/s00134-005-2611-7

Cited by 10 publications

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“…7 The benefits of reducing instrumental dead space or mitigating its effects are well-recognized and discussed in the literature. 8,9 Multiple approaches to reduce instrumental dead space and/or its effects on patients have been proposed; 3,[8][9][10][11][12][13][14][15] these suggestions even include using lung assist with extracorporeal CO 2 removal. 16 However, trimming the endotracheal tube (ETT) seems to be the only widely accepted method.…”

Section: Introductionmentioning

confidence: 99%

Reduction of Endotracheal Tube Connector Dead Space Improves Ventilation: A Bench Test on a Model Lung Simulating an Extremely Low Birth Weight Neonate

Ivanov

2015

Respir Care

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BACKGROUND: The reduction of instrumental dead space is a recognized approach to preventing ventilation-induced lung injury in premature infants. However, there are no published data regarding the effectiveness of instrumental dead-space reduction in endotracheal tube (ETT) connectors. We tested the impact of the Y-piece/ETT connector pairs with reduced instrumental dead space on CO 2 elimination in a model of the premature neonate lung. METHODS: The standard ETT connector was compared with a low-dead-space ETT connector and with a standard connector equipped with an insert. We compared the setups by measuring the CO 2 elimination rate in an artificial lung ventilated via the connectors. The lung was connected to a ventilator via a standard circuit, a 2.5-mm ETT, and one of the connectors under investigation. The ventilator was run in volume-controlled continuous mandatory ventilation mode. RESULTS: The low-dead-space ETT connector/Y-piece and insert-equipped standard connector/Y-piece pairs had instrumental dead space reduced by 36 and 67%, respectively. With set tidal volumes (V T ) of 2.5, 5, and 10 mL, in comparison with the standard ETT connector, the low-dead-space connector reduced CO 2 elimination time by 4.5% (P < .05), 4.4% (P < .01), and 7.1% (not significant), respectively. The insert-equipped standard connector reduced CO 2 elimination time by 13.5, 25.1, and 16.1% (all P < .01). The low-dead-space connector increased inspiratory resistance by 17.8% (P < .01), 9.6% (P < .05), and 5.0% (not significant); the insert-equipped standard connector increased inspiratory resistance by 9.1, 8.4, and 5.9% (all not significant). The low-dead-space connector decreased expiratory resistance by 6.8% (P < .01) and 1.8% (not significant) and increased it by 1.4% (not significant); the insert-equipped standard connector decreased expiratory resistance by 1.5 and 1% and increased it by 1% (all not significant). The low-dead-space connector increased work of breathing by 4.7% (P < .01), 3.8% (P < .01), and 2.5% (not significant); the insert-equipped standard connector increased it by 0.8% (not significant), 2.5% (P < .01), and 2.8% (P < . IntroductionVentilator-induced lung injury is considered an important causative factor in the pathophysiology of bronchopulmonary dysplasia (BPD) in premature infants. 1 Limiting ventilator-associated lung overdistention/damage is a well-recognized approach for the prevention of BPD, but Dr Ivanov is affiliated with the Section

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Section: Introductionmentioning

confidence: 99%

Reduction of Endotracheal Tube Connector Dead Space Improves Ventilation: A Bench Test on a Model Lung Simulating an Extremely Low Birth Weight Neonate

Ivanov

2015

Respir Care

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“…In our previous studies (5,6), flow measurement was only possible during periods of split‐flow interruption. As no flow sensor was integrated into the split‐flow line, the flow sensor customarily placed in the patient limb of the Y‐piece would have yielded wrong, too high expiratory flow values by measuring not only the breathing gas returning from the patient's airways, but also the fresh gas entering from the split‐flow line.…”

Section: Discussionmentioning

confidence: 99%

“…According to the literature, employment of CTGI as well as leakage flow has resulted in ventilation requirement reductions of 20 to 40% (9–12). In a first pilot study, we also achieved a reduction of 20 to 40% with split‐flow ventilation (5,6). This means that besides the aforementioned technical advantages, our method proved equally efficient.…”

Section: Discussionmentioning

confidence: 99%

“…The basic split‐flow ventilation circuit constructed as previously described (5,6) was further modified as follows: a flow sensor (FS‐1) (“Fabian” flow sensor and respiratory volumeter for premature infants and neonates; Accutronics Co., Baar, Switzerland) was modified such that the “split‐flow” bypass tube could be related to the connection piece of the ETT in the immediate vicinity of the flow sensor. A second Fabian flow sensor (FS‐2) was integrated into the split‐flow bypass tube.…”

Section: Methodsmentioning

confidence: 99%

“…“Split‐flow ventilation” is a method recently invented by our working group which offers a way of functional aDS diminution (5,6). Part of the flow generated by the ventilator is branched off the afferent limb of the ventilation circuit via an additional tube which bypasses the Y‐piece and the flow sensor, and rejoins the patient limb at the level of the connection piece of the endotracheal tube (ETT) (Fig.…”

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A Flow Sensor Suitable for Use With Split‐flow Ventilation—First Preclinical Data

Wald¹,

Jeitler²,

Lawrenz³

et al. 2006

Artificial Organs

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Volutrauma caused by artificial ventilation represents a major morbidity risk for premature infants. Our working group has recently developed an innovative "split-flow ventilation" system aiming at the reduction of tidal volumes (TVs). The main problem for the practical use of this system is the fact that conventional measurements of commercially available flow sensors are distorted by the split flow. In this study, we present the first preclinical data from testing an adapted flow sensor combination recognizing the split flow. A preterm infant test lung was conventionally ventilated, modified by insertion of a split-flow line. In addition to the customary flow sensor (FS-1), a second flow sensor (FS-2) was integrated into the split-flow line, and a third (FS-3) was placed at the exit of the test lung for reference measurements. The signals of all three flow sensors were read and processed by a computer. The program was set to graphically add up flow curves 1, 2, and 3 during one ventilation loop. After 10 runs, a mean curve of FS-1+2 was calculated and compared to the mean curve of FS-3. Furthermore, the mean TV of 10 runs measured by FS-1+2 was calculated and compared with the mean TV calculated by FS-3. The summation curve FS-1+2 proved identical to the reference curve FS-3. FS-1+2 yielded a TV of 6.6 +/- 0.01 mL (inspiratory) and 6.7 +/- 0.02 mL (expiratory). The corresponding values of FS-3 were 6.5 +/- 0.20 mL and 6.6 +/- 0.09 mL, respectively. According to our results, the presented flow sensor constellation allows exact flow measurements in the experimental setting and appears suitable for usage in a split-flow ventilation circuit under clinical conditions.

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Tracheal gas insufflation for the prevention of morbidity and mortality in mechanically ventilated newborn infants

Davies

Woodgate

2002

Cochrane Database of Systematic Reviews

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Dead-space washout by split-flow ventilation. A new method to reduce ventilation needs in premature infants

Abstract: Split-flow ventilation significantly reduces apparatus dead space during ventilation in preterm infants. This leads to reduced ventilatory effort.

Cited by 10 publications

References 13 publications

Reduction of Endotracheal Tube Connector Dead Space Improves Ventilation: A Bench Test on a Model Lung Simulating an Extremely Low Birth Weight Neonate

Reduction of Endotracheal Tube Connector Dead Space Improves Ventilation: A Bench Test on a Model Lung Simulating an Extremely Low Birth Weight Neonate

A Flow Sensor Suitable for Use With Split‐flow Ventilation—First Preclinical Data

Tracheal gas insufflation for the prevention of morbidity and mortality in mechanically ventilated newborn infants

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