Effect of the Y-piece of the ventilation circuit on ventilation requirements in extremely low birth weight infants

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

doi:10.1007/s00134-005-2711-4

Cited by 11 publications

(16 citation statements)

References 29 publications

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“…This phenomenon was previously observed in vivo 4 and implied in bench tests. 21,24 This study actually demonstrated that the CO 2 elimination was complete in the bench model.…”

Section: Discussionmentioning

confidence: 57%

“…20,21 These models eliminate the uncontrollable variables that are often present in living beings. The model used by Wald et al 21 is based on measurement of the CO 2 removal rate from a test lung connected to a ventilator with the equipment under the test. Using this model was especially attractive because the model permits the direct measurement of the patientrelevant parameters of the respiratory equipment.…”

Section: Introductionmentioning

confidence: 99%

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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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“…This phenomenon was previously observed in vivo 4 and implied in bench tests. 21,24 This study actually demonstrated that the CO 2 elimination was complete in the bench model.…”

Section: Discussionmentioning

confidence: 57%

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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“…We devised a modification of a technique used previously to evaluate the effect of various configurations of flow sensors on the effectiveness of CO 2 removal 13. The simple premise of our approach is that if the V T is insufficient to clear the DS, then no CO 2 is washed out from the test lung and none is detected by the ETCO 2 sensor.…”

Section: Methodsmentioning

confidence: 99%

Effective ventilation at conventional rates with tidal volume below instrumental dead space: a bench study

Keszler

Montaner

Abubakar

2011

Arch Dis Child Fetal Neonatal Ed

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“…This has a relevant effect on ventilation requirements, especially in ELBW neonates, which can be particularly unfavorable during the weaning procedure [23,24]. Furthermore, it might contribute to the development of chronic lung disease by increasing volutrauma [24]. Additionally, the catheter might considerably compromise ventilation if accidentally not drawn back entirely.…”

Section: Discussionmentioning

confidence: 99%

“…The built-in Y-connector, imposing an extra volume of 2 ml compared to 0.4 ml for the regular tube adapter, represents a disadvantage. This has a relevant effect on ventilation requirements, especially in ELBW neonates, which can be particularly unfavorable during the weaning procedure [23,24]. Furthermore, it might contribute to the development of chronic lung disease by increasing volutrauma [24].…”

Section: Discussionmentioning

confidence: 99%

Closed versus Open Endotracheal Suctioning in Extremely Low-Birth-Weight Neonates: A Randomized, Crossover Trial

Pirr¹,

Lange²,

Hartmann³

et al. 2012

Neonatology

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Background: Endotracheal suctioning, which is frequently necessary in mechanically ventilated patients, might cause complications, especially in patients with compromised lung function such as extremely low-birth-weight (ELBW) neonates. Objectives: To investigate whether closed endotracheal suctioning (CS) reduces the frequency of hypoxemia and bradycardia in ELBW neonates compared to open suctioning (OS). Methods: In a randomized, crossover trial, 15 ventilated ELBW neonates (mean birth weight 655 g) underwent suctioning with both techniques. Data on oxygen saturation (Spo₂), heart rate (HR), arterial blood pressure, arterial blood gases, duration of the suctioning procedure and recovery time were collected. Statistical analysis was done using the SPSS t test for paired samples. Results: The mean frequency of hypoxemia <85% was significantly decreased (p = 0.012) during CS (0.5) versus OS (1.1). The mean minimum Spo₂ was significantly higher (p = 0.012) during CS (87%) compared to OS (84%), and a significantly less steep drop in mean Spo₂ (p = 0.007) (CS: –5%, OS: –8%) was found. Mean arterial Po₂ (p = 0.035; CS: 59 mm Hg, OS: 53 mm Hg) and mean oxygenation ratio (p = 0.016; CS: 197, OS: 171) were significantly higher after CS. No significant differences were found in HR, incidence or duration of bradycardia, recovery time, arterial blood pressure, duration of suctioning, number of complications, or duration of hypoxemia. Conclusion: CS was superior to OS on oxygenation values. To prove its overall superiority, further research is required. So, in this group of patients, CS should currently be administered on an individual basis.

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Effect of the Y-piece of the ventilation circuit on ventilation requirements in extremely low birth weight infants

Cited by 11 publications

References 29 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

Effective ventilation at conventional rates with tidal volume below instrumental dead space: a bench study

Closed versus Open Endotracheal Suctioning in Extremely Low-Birth-Weight Neonates: A Randomized, Crossover Trial

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