Flow requirements for a modified mapleson D system during controlled ventilation

Bain, James A.; Spoerel, W. E.

doi:10.1007/bf03026260

Cited by 93 publications

(17 citation statements)

References 10 publications

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“…Mainly they have used large minute volumes of ventilation under rebreathing conditions caused by the use of low fresh gas flows. Of these formulae, those by Bain and Spoerel [6,7] and Rose and Froese [8] are the simplest (Table 1). Bain and Spoerel [7] reported that most children under 20 kg body weight were found to be mildly to moderately hypocapnoeic with a fresh gas flow of 3.5 l.min ¹1 and, without presenting study results, they recommended a fresh gas flow of 2 l.min ¹1 , regardless of age or body weight, for children under 10 kg body weight to avoid marked respiratory alkalosis.…”

Section: Discussionmentioning

confidence: 99%

Predictable normocapnoea in controlled ventilation of infants with Jackson Rees or Bain system

et al. 1998

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SummaryWe have devised a formula for ventilator settings which would provide normal minute ventilation without rebreathing during controlled ventilation using a Jackson Rees or Bain system. Asthe volume of fresh gas entering during the inspiratory phase and V L ¼ the lost volume due to the compliance of the system, V S was derived:where a ¼ expiratory-to-inspiratory ratio and b ¼ the ratio of fresh gas flow to the minute ventilation. It was evaluated in 62 infants. Arterial partial pressure of carbon dioxide (mean (SD)) was 4.6 (0.5) kPa (35 (4) mmHg) with a range of 3.42-5.78 kPa (26-44 mmHg). The 90th percentile was 5.1 kPa (39 mmHg). It is concluded that predictable normocapnoea can be conveniently achieved in infants in controlled ventilation with Jackson Rees or Bain system if our formula is applied. The Jackson Rees and Bain breathing systems, which are similar to a Mapleson D system and operate in the same way, are popular for paediatric anaesthesia, especially for head and neck surgery, due to their light weight, minimal volume, mechanical simplicity and easy positioning. They are commonly used for mechanically controlled ventilation in paediatric anaesthesia because manual ventilation may limit the anaesthetist's ability to manage unexpected problems. Many recommendations have been suggested for fresh gas flow and minute ventilation in attempts to provide predictable alveolar ventilation during mechanical ventilation with modified Mapleson D systems. Basically, there are two ways of using the D system. One is to use a large total ventilation with a relatively low fresh-gas flow so that the alveolar ventilation is limited by, and somewhat less than, the fresh-gas flow. The other method is to eliminate rebreathing by using a large fresh-gas flow and then setting a relatively small total ventilation so that the alveolar ventilation is limited by, and rather less than, the total ventilation. This second method can of course be used with any nonrebreathing system. The first method is used by most authors and we have explored the second. Methods

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Section: Discussionmentioning

confidence: 99%

Predictable normocapnoea in controlled ventilation of infants with Jackson Rees or Bain system

et al. 1998

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“…When establishing the fresh gas flows required to produce mild hypocapnia (1 00 ml.min-'.kg-l) or normocapnia (70 ml.min-l.kg-') with controlled ventilation at 150 ml.min-l.kg-l using their breathing system, Bain and Spoerel did not note differences in these requirements with regard to gender nor did they note the tidal volume and respiratory frequency used [2]. Since it is considered safer to hyperventilate patients during surgery when capnography is not available [l], patients' lungs can be ventilated at 10 breath.min-l using tidal volumes of 9 ml.kg-' for males and 8 ml.kg-' for females with fresh gas flows equal to minute ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…W'CO, 4.0 kPa) in adult males and females, and how induced hypocapnia can best be reversed to stimulate spontaneous ventilation at the end of surgery. The fresh gas flows required to maintain normocapnia (70 ml.min-'.kg-l) or mild hypocapnia (100 ml.min-'.kg-') using the Bain system with controlled ventilation at 150 ml.min-'.kg-' have been established [2]. However, no difference in these requirements with regard to gender was noted, nor was the respiratory frequency when this breathing system was used.…”

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confidence: 99%

Controlled ventilation with the Bain co‐axial system

Savva

1993

Anaesthesia

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“…It has a Heidbrink or similar valve and a reservoir bag at the proximal (machine) end [2], thus forming a modified Mapleson D system. Recommended fresh gas flow (VFG) rates are 70 ml.kg-l.min-l for controlled ventilation [3] and 10&300 ml.kg-'.min-l for spontaneous breathing [MI. Our aim was to preserve the simplicity and compactness of the co-axial Bain system, but to reduce the fresh gas (FG) requirements.…”

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confidence: 99%