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Quantification of reservoir bags as airway pressure-limiting devices in a nonrebreathing system

  • Tamas D. Ambrisko
    Correspondence
    Correspondence: Tamas D Ambrisko, Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, 1008 West Hazelwood Drive, Urbana, IL 61802, USA.
    Affiliations
    Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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  • Arnon Gal
    Affiliations
    Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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  • Jesus N. Sarol Jr
    Affiliations
    Illinois Biostatistics, Epidemiology and Research Design Core, Interdisciplinary Health Sciences Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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  • Ashley Mitek
    Affiliations
    Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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  • Christina Braun
    Affiliations
    Anaesthesiology and Perioperative Intensive-Care Medicine, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
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Published:December 10, 2020DOI:https://doi.org/10.1016/j.vaa.2020.11.004

      Abstract

      Objective

      To evaluate the influence of reservoir bag types, volumes and previous use on the peak pressures (Pmax) and the times to develop 30 cmH2O pressure (P30) within a nonrebreathing system with a closed adjustable pressure-limiting (APL) valve.

      Study design

      In vitro study using three-way factorial design with repeated measure on one factor.

      Subjects

      A total of 75 new anesthesia reservoir bags (five types, three volumes, five bags from each type × volume). The bag types were reusable latex (RL), disposable latex (DL) and three disposable neoprene (DN-1, DN-2 and DN-3).

      Methods

      Each bag was tested three times (treatments): new, after prestretching and 1 week later. The bags were attached to a Bain system and anesthesia machine with closed APL valve and patient port with O2 flow 2 L minute–1 until Pmax was reached. The Pmax and time to reach P30 values were determined from recorded pressure traces. General linear mixed model analysis was used to examine the effects of bag type, volume and treatment. One-sided 95% upper prediction limits of Pmax were calculated to test the null hypothesis that predicted Pmax of new bags would be ≥ 50 cmH2O for each factor combination.

      Results

      RL bags were the least and DN-3 bags were the most compliant. Prestretching increased compliance in all bag types. Smaller bags of RL, DL and DN-1 were less compliant than larger ones. The predicted Pmax values were < 50 cmH2O only for DN-3 bags after prestretching. The time to reach P30 was critically low when using 0.5 L bags (median 17 seconds).

      Conclusions and clinical relevance

      To minimize the risk of barotrauma, highly compliant reservoir bags (e.g. DN-3) are recommended and reusable bags should be avoided. Bags should be prestretched before first use, 0.5 L bags should be avoided and fresh gas flow minimized.

      Keywords

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