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The effect of increased apparatus dead space and tidal volumes on carbon dioxide elimination and oxygen saturations in a low-flow anesthesia system.

Enekvist, Bruno LU ; Luttropp, Hans-Henrik LU and Johansson, Anders LU (2008) In Journal of Clinical Anesthesia 20(3). p.170-174
Abstract
STUDY OBJECTIVE: To determine if a large tidal volume (V(T)), with an unchanged end-tidal carbon dioxide partial pressure (P(ET)co(2)), could improve arterial carbon dioxide elimination, oxygen saturation (Spo(2)), and arterial blood oxygenation. DESIGN: Prospective, randomized, clinical study. SETTING: Single university hospital. PATIENTS: 60 ASA physical status I and II patients scheduled for elective urologic or general surgery. INTERVENTIONS: Patients were randomly assigned to one of two treatments: patients in group 1, nondead space (NDS), received a fresh gas flow of 1 L/min without added apparatus dead space volume. Patients in group 2, dead space (DS), received ventilation using an added dead space volume between the Y-piece and... (More)
STUDY OBJECTIVE: To determine if a large tidal volume (V(T)), with an unchanged end-tidal carbon dioxide partial pressure (P(ET)co(2)), could improve arterial carbon dioxide elimination, oxygen saturation (Spo(2)), and arterial blood oxygenation. DESIGN: Prospective, randomized, clinical study. SETTING: Single university hospital. PATIENTS: 60 ASA physical status I and II patients scheduled for elective urologic or general surgery. INTERVENTIONS: Patients were randomly assigned to one of two treatments: patients in group 1, nondead space (NDS), received a fresh gas flow of 1 L/min without added apparatus dead space volume. Patients in group 2, dead space (DS), received ventilation using an added dead space volume between the Y-piece and tracheal tube. In both groups, patients' lungs were ventilated to a fixed P(ET)co(2) value of 33.8 mmHg. Patients in the DS group were ventilated with V(T)s to maintain an airway plateau pressure (P(plateau)) of 0.04 cm H(2)O/kg over initial plateau pressure. The corrugated tube was then adjusted to maintain a fixed P(ET)co(2). MEASUREMENTS: Dead space volumes, P(ET)co(2), arterial CO(2) tension (Paco(2)), SpO(2), arterial O(2) tension (Pao(2)), V(T)s, and airway pressures were measured. MAIN RESULTS: Arterial CO(2) tension was significantly lower in the DS group, 36 +/- 2.3 mmHg, compared with the NDS group, 37.5 +/- 2.3 mmHg (P < 0.05), and the difference between P(ET)co(2) and Paco(2) was lower in the DS group than in the NDS group (P < 0.001). Oxygen saturation was 99% +/- 1.0% in the DS group compared with 98.5% +/- 1.5% in the NDS group (P < 0.05). Arterial O(2) tension was 13.2 +/- 25.5 mmHg in the DS group and 119.1 +/- 30.2 mmHg in NDS group (not significant). CONCLUSION: Larger V(T)s, with an unchanged P(ET)CO(2) concentration created by an added apparatus dead space volume, improved arterial carbon dioxide elimination. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Clinical Anesthesia
volume
20
issue
3
pages
170 - 174
publisher
Elsevier
external identifiers
  • wos:000256730800003
  • pmid:18502358
  • scopus:43849091920
ISSN
1873-4529
DOI
10.1016/j.jclinane.2007.09.013
language
English
LU publication?
yes
id
e0887418-968b-4ef9-896e-167a0c8470c4 (old id 1153785)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/18502358?dopt=Abstract
date added to LUP
2009-07-27 14:59:13
date last changed
2017-08-13 03:46:46
@article{e0887418-968b-4ef9-896e-167a0c8470c4,
  abstract     = {STUDY OBJECTIVE: To determine if a large tidal volume (V(T)), with an unchanged end-tidal carbon dioxide partial pressure (P(ET)co(2)), could improve arterial carbon dioxide elimination, oxygen saturation (Spo(2)), and arterial blood oxygenation. DESIGN: Prospective, randomized, clinical study. SETTING: Single university hospital. PATIENTS: 60 ASA physical status I and II patients scheduled for elective urologic or general surgery. INTERVENTIONS: Patients were randomly assigned to one of two treatments: patients in group 1, nondead space (NDS), received a fresh gas flow of 1 L/min without added apparatus dead space volume. Patients in group 2, dead space (DS), received ventilation using an added dead space volume between the Y-piece and tracheal tube. In both groups, patients' lungs were ventilated to a fixed P(ET)co(2) value of 33.8 mmHg. Patients in the DS group were ventilated with V(T)s to maintain an airway plateau pressure (P(plateau)) of 0.04 cm H(2)O/kg over initial plateau pressure. The corrugated tube was then adjusted to maintain a fixed P(ET)co(2). MEASUREMENTS: Dead space volumes, P(ET)co(2), arterial CO(2) tension (Paco(2)), SpO(2), arterial O(2) tension (Pao(2)), V(T)s, and airway pressures were measured. MAIN RESULTS: Arterial CO(2) tension was significantly lower in the DS group, 36 +/- 2.3 mmHg, compared with the NDS group, 37.5 +/- 2.3 mmHg (P &lt; 0.05), and the difference between P(ET)co(2) and Paco(2) was lower in the DS group than in the NDS group (P &lt; 0.001). Oxygen saturation was 99% +/- 1.0% in the DS group compared with 98.5% +/- 1.5% in the NDS group (P &lt; 0.05). Arterial O(2) tension was 13.2 +/- 25.5 mmHg in the DS group and 119.1 +/- 30.2 mmHg in NDS group (not significant). CONCLUSION: Larger V(T)s, with an unchanged P(ET)CO(2) concentration created by an added apparatus dead space volume, improved arterial carbon dioxide elimination.},
  author       = {Enekvist, Bruno and Luttropp, Hans-Henrik and Johansson, Anders},
  issn         = {1873-4529},
  language     = {eng},
  number       = {3},
  pages        = {170--174},
  publisher    = {Elsevier},
  series       = {Journal of Clinical Anesthesia},
  title        = {The effect of increased apparatus dead space and tidal volumes on carbon dioxide elimination and oxygen saturations in a low-flow anesthesia system.},
  url          = {http://dx.doi.org/10.1016/j.jclinane.2007.09.013},
  volume       = {20},
  year         = {2008},
}