title: Beware the airway filter: deadspace effect in children under 2 years.
abstract: BACKGROUND
  Filters are increasingly used in breathing circuits as they protect the circuit from contamination and facilitate humidification of inspired gas. The use of filters, however, can augment the anatomical deadspace. This can be significant in children because they have much smaller tidal volumes.
  
  
  METHODS
  Following institutional ethical approval, 20 healthy children <2 years of age who required tracheal intubation were recruited. Ventilation was adjusted to achieve an endtidal carbon dioxide (P(E)CO(2)) of 4.6 kPa (35 mmHg) when sampled at the tracheal tube (TT) adapter. Following a 10-min period of stabilization, an airway filter (22 ml) was introduced into the circuit. The respiratory rate (RR) was then adjusted to return P(E)CO(2) to 4.6 kPa (35 mmHg).
  
  
  RESULTS
  A mean increase in ventilation of 1.42 (0.38) l x min(-1) was required to maintain a normal P(E)CO(2) level. Airway pressure and respiratory rate increased by 7.9 mmHg (4.6) and 19.8 breath x min(-1) (8.7) respectively. The P(E)CO(2) and partial pressure of inspired carbon-di-oxide (PiCO(2)) measured from the TT adapter were higher than measured from the filter port. The mean increase was 3.6 (1.6) mmHg for P(E)CO(2) and 5.9 (3.9) mmHg for PiCO(2).
  
  
  CONCLUSIONS
  Amplified deadspace from airway filters results in a significant increase in ventilation needed to maintain a normal P((E)CO(2) in children <2 years of age with normal lungs. Sampling of P((E)CO(2) and PiCO(2) from the filter significantly underestimates the effect of increased deadspace. The effect of increased deadspace may be predicted using a proposed mathematical model.
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Chau
authors.forename: Jeff
authors.initials: J
authors.lastname: Kobe
authors.forename: Raman
authors.initials: R
authors.lastname: Kalyanaraman
authors.forename: Clayton
authors.initials: C
authors.lastname: Reichert
authors.forename: Mark
authors.initials: M
authors.lastname: Ansermino
mesh_terms: D002245:Carbon Dioxide / Q000378:metabolism; D005260:Female; D005374:Filtration / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D012126:Respiratory Dead Space / Q000502:physiology*
chemical_list: D002245:Carbon Dioxide