A comparison of three modes of ventilation with the use of an adult circle system in an infant lung model.
We examined the efficiency of an adult circle system with adult bellows to deliver minute ventilation (VE) to an infant test lung model. A Narkomed 2B system (North American Drager, Telford, PA) using three modes of ventilator setup were used: A = time-cycled, volume-controlled using bellows excursion to control delivered volume; B = time-cycled, pressure-controlled using inspiratory pressure limit adjustment to control delivered volume; C = time-cycled, pressure-controlled using the inspiratory flow adjustment to control delivered volume. VE was measured with two compliances (normal and low) and four endotracheal tube (ETT) sizes (2.5-, 3.0-, 3.5-, and 4.0-mm inner diameter). VE was measured at peak inspiratory pressures (PIP) of 20, 30, 40 or 50 cm H2O while respiratory rate (RR) was held constant at 20 breaths/min. VE was measured as RR was set at 20, 30, 40, or 50 breaths/min while target PIP was held constant at 20 cm H2O. Data were analyzed using the multiple regression technique. With the low compliance model, VE was nearly identical regardless of the ventilator setup. With the normal compliance model, minor differences in VE were observed, especially at the highest RR and PIP. VE was dependent on RR, PIP, and lung compliance. Overall, the ventilator setup resulted in minor changes in VE. Very high PIPs were required to deliver VE to the low compliance model. ETT size did not affect VE when lung compliance was low; however, smaller ETT size was a factor when test lung compliance was normal, decreasing delivered VE at higher PIP and RR. We conclude that with a Narkomed 2B adult circle system VE is dependent on PIP, RR, and lung compliance, but not on mode of ventilator setup.


CONCLUSIONS
The results of this laboratory investigation indicate that when an adult circle system is used during infant anesthesia, the ventilation delivered depends primarily on the respiratory rate, peak inspiratory pressure, and the compliance of the lung being ventilated, rather than on the specific mode of ventilator setup.
Department of Anesthesiology, Children's Memorial Hospital and Northwestern University Medical School, Chicago, Illinois 60614, USA.
M J
MJ
Tobin
G W
GW
Stevenson
B J
BJ
Horn
E H
EH
Chen
S C
SC
Hall
C J
CJ
Coté
D000328:Adult; D000764:Anesthesia, Closed-Circuit / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000295:instrumentation; D008168:Lung / Q000502:physiology*; D008170:Lung Compliance; D008961:Models, Structural; D012123:Pulmonary Ventilation; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods*