Coronavirus Disease 2019: Anesthesia Machine Circuit Pressure During Use as an Improvised Intensive Care Unit Ventilator
| Autor: | William C. Culp, Kendall A P Hammonds, Courtney Shaver, Vinh Pham, Riley J Hedin, Le Nguyen |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Critical Care
Respiratory rate medicine.medical_treatment Peak inspiratory pressure law.invention Positive-Pressure Respiration 03 medical and health sciences 0302 clinical medicine Anesthesiology 030202 anesthesiology law Fraction of inspired oxygen medicine Humans Anesthesia Continuous positive airway pressure Tidal volume Ventilators Mechanical business.industry COVID-19 Respiration Artificial Fresh gas flow Intensive Care Units Anesthesiology and Pain Medicine Ventilation (architecture) Breathing business 030217 neurology & neurosurgery |
| Zdroj: | Anesthesia & Analgesia. 132:1191-1198 |
| ISSN: | 0003-2999 |
| DOI: | 10.1213/ane.0000000000005427 |
| Popis: | BACKGROUND: Use of anesthesia machines as improvised intensive care unit (ICU) ventilators may occur in locations where waste anesthesia gas suction (WAGS) is unavailable. Anecdotal reports suggest as much as 18 cm H2O positive end-expiratory pressure (PEEP) being inadvertently applied under these circumstances, accompanied by inaccurate pressure readings by the anesthesia machine. We hypothesized that resistance within closed anesthesia gas scavenging systems (AGSS) disconnected from WAGS may inadvertently increase circuit pressures. METHODS: An anesthesia machine was connected to an anesthesia breathing circuit, a reference manometer, and a standard bag reservoir to simulate a lung. Ventilation was initiated as follows: volume control, tidal volume (TV) 500 mL, respiratory rate 12, ratio of inspiration to expiration times (I:E) 1:1.9, fraction of inspired oxygen (Fio2) 1.0, fresh gas flow (FGF) rate 2.0 liters per minute (LPM), and PEEP 0 cm H2O. After engaging the ventilator, PEEP and peak inspiratory pressure (PIP) were measured by the reference manometer and the anesthesia machine display simultaneously. The process was repeated using prescribed PEEP levels of 5, 10, 15, and 20 cm H2O. Measurements were repeated with the WAGS disconnected and then were performed again at FGF of 4, 6, 8, 10, and 15 LPM. This process was completed on 3 anesthesia machines: Drager Perseus A500, Drager Apollo, and the GE Avance CS2. Simple linear regression was used to assess differences. RESULTS: Utilizing nonparametric Bland-Altman analysis, the reference and machine manometer measurements of PIP demonstrated median differences of -0.40 cm H2O (95% limits of agreement [LOA], -1.00 to 0.55) for the Drager Apollo, -0.40 cm H2O (95% LOA, -1.10 to 0.41) for the Drager Perseus, and 1.70 cm H2O (95% LOA, 0.80-3.00) for the GE Avance CS2. At FGF 2 LPM and PEEP 0 cm H2O with the WAGS disconnected, the Drager Apollo had a difference in PEEP of 0.02 cm H2O (95% confidence interval [CI], -0.04 to 0.08; P = .53); the Drager Perseus A500 |
| Databáze: | OpenAIRE |
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