Effect of Heat and Moisture Exchange Filter on the Dead Space Ventilation in a Pediatric Patient

Bhagwat, Mrunmayee; Surve, Rohini M.; Patwardhan, Prathamesh M.

doi:10.1055/s-0041-1731602

Cited by 1 publication

(2 citation statements)

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“…Of note, in small pediatric patients, it was reported that the dead space applied by HMEF induced CO 2 retention and EtCO 2 monitoring on the Y-piece side of HMEF failed to detect elevated CO 2 [ 10 , 27 ]. Our study results should not be applied to pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of mainstream end tidal carbon dioxide on Y-piece side versus patient side of heat and moisture exchanger filters in critically ill adult patients: a prospective observational study

Tamashiro

Nakayama

Gibo

et al. 2022

J Clin Monit Comput

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The purpose of the study was to investigate the accuracy of mainstream EtCO 2 measurements on the Y-piece (filtered) side of the heat and moisture exchanger filter (HMEF) in adult critically ill patients, compared to that on the patient (unfiltered) side of HMEF. We conducted a prospective observational method comparison study between July 2019 and December 2019. Critically ill adult patients receiving mechanical ventilation with HMEF were included. We performed a noninferiority comparison of the accuracy of EtCO 2 measurements on the two sides of HMEF. The accuracy was measured by the absolute difference between PaCO 2 and EtCO 2 . We set the non-inferiority margin at + 1 mmHg in accuracy difference between the two sides of HMEF. We also assessed the agreement between PaCO 2 and EtCO 2 using Bland–Altman analysis. Among thirty-seven patients, the accuracy difference was − 0.14 mmHg (two-sided 90% CI − 0.58 to 0.29), and the upper limit of the CI did not exceed the predefined margin of + 1 mmHg, establishing non-inferiority of EtCO 2 on the Y-piece side of HMEF ( P for non-inferiority < 0.001). In the Bland–Altman analyses, 95% limits of agreement between PaCO 2 and EtCO 2 were similar on both sides of HMEF (Y-piece side, − 8.67 to + 10.65 mmHg; patient side, − 8.93 to + 10.67 mmHg). The accuracy of mainstream EtCO 2 measurements on the Y-piece side of HMEF was noninferior to that on the patient side in critically ill adults. Mechanically ventilated adult patients could be accurately monitored with mainstream EtCO 2 on the Y-piece side of the HMEF unless their tidal volume was extremely low. Supplementary Information The online version contains supplementary material available at 10.1007/s10877-022-00901-6.

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Section: Discussionmentioning

confidence: 99%

“…Previous studies reported that EtCO 2 measured with the sidestream method on the Y-piece side of HMEF showed lower values than that on the patient side [ 8 , 9 ]. Inaccurately low EtCO 2 values could lead to misrecognition of CO 2 retention and threaten patient safety [ 10 ].…”

Section: Introductionmentioning

confidence: 99%