What is the optimal device for carbon dioxide deairing of the cardiothoracic wound and how should it be positioned?
OBJECTIVE
To compare recently described insufflation devices for efficient carbon dioxide (CO(2)) deairing of the cardiothoracic wound and to determine the importance of their position.


METHODS
Experimental and clinical.


METHODS
A cardiothoracic operating room at a university hospital.


METHODS
A full-size torso with a cardiothoracic wound and 10 patients undergoing cardiac surgery.


METHODS
Insufflation of CO(2) into the wound cavity at 2.5, 5, 7.5, and 10 L/min with a multiperforated catheter and a 2.5-mm tube with either a gauze sponge or a gas-diffuser of polyurethane foam at its end. The devices were tested when positioned at the level of the wound opening and 5 cm below and after exposure to fluid.


RESULTS
Deairing was assessed by measuring the remaining air content at the right atrium. With the multiperforated catheter, the gauze sponge, and the gas-diffuser, the lowest median air content in the torso was 8.4%, 2.5%, and 0.3%, respectively (p < 0.001), when positioned inside the wound cavity. When exposed to fluid, the gauze sponge and the multiperforated catheter immediately became inefficient (70% and 96% air, respectively), whereas the gas-diffuser remained efficient (0.4% air). During surgery, the gas-diffuser provided a median air content of 1.0% at 5 L/min, and 0.7% at 10 L/min.


CONCLUSIONS
For efficient deairing, CO(2) has to be delivered from within the wound cavity. The gas-diffuser was the most efficient device. In contrast to a gas-diffuser, a multiperforated catheter or a gauze sponge is unsuitable for CO(2) deairing because they will stop functioning when they get wet in the wound.
Persson
Mikael
M
Department of Cadiothoracic Surgery and Anesthesiology, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden. m.persson@labmed.ki.se
Svenarud
Peter
P
van der Linden
Jan
J
D000368:Aged; D000704:Analysis of Variance; D001826:Body Fluids; D002245:Carbon Dioxide / Q000008:administration & dosage*; D006348:Cardiac Surgical Procedures / Q000295:instrumentation*; D004618:Embolism, Air / Q000209:etiology / Q000517:prevention & control; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006325:Heart Atria / Q000033:anatomy & histology; D006801:Humans; D007327:Insufflation / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D035423:Thoracic Cavity / Q000033:anatomy & histology / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome
D002245:Carbon Dioxide