J Clin Monit Comput - Hypoxic guard systems do not prevent rapid hypoxic inspired mixture formation.

Tópicos

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Resumo

Because a case report and theoretical mass balances suggested that hypoxic guard systems may not prevent the formation of hypoxic inspired mixtures (FIO2 = 21 %) over the clinically used fresh gas flow (FGF) range, we measured FIO2 over a wide range of hypoxic guard limits for O2/N2O and O2/air mixtures. After IRB approval, 16 ASA I-II patients received sevoflurane in either O2/N2O (n = 8) or O2/air (n = 8) using a Zeus(?) anesthesia machine in the conventional mode. After using an 8 L/min FGF with FDO2 = 25% for 10 min, the following hypoxic guard limits were tested for 4 min each, expressed as [total FGF in L/min; FDO2 in %]: [0.3;85], [0.4;65], [0.5;50], [0.7;36], [0.85;30], [1.0;25], [1.25;25], [1.5;25], [2;25], [3;25], [5;25], and [8;25]. In between these [FGF;FDO2] combinations, 8 L/min FGF with 25% O2 was used for 4 min to return to the same baseline FIO2 (25%) before the start of the next combination. This sequence was studied once in each patient receiving O2/air (n = 8), but twice in each patient who received O2/N2O (n = 8) to examine the effect of decreasing N2O uptake over time, resulting in three groups: early O2/N2O, late O2/N2O, and O2/air group. The [FGF;FDO2]-FIO2 relationship was examined. The overall [FGF;FDO2]-FIO2 relationship in the three groups was similar. In all 1, 1.25, and 1.5 L/min FGF groups, FIO2 decreased below 21% in all but one patient; this occurred within 1 min in at least one patient. In the 0.7 L/min O2/air group and the 3 L/min late O2/N2O and O2/air groups, FIO2 decreased below 21% in one patient. Current hypoxic guard systems do not reliably prevent a hypoxic FIO2 with O2/N2O and O2/air mixtures, particularly between 0.7 and 3 L/min.

Resumo Limpo

case report theoret mass balanc suggest hypox guard system may prevent format hypox inspir mixtur fio clinic use fresh gas flow fgf rang measur fio wide rang hypox guard limit ono oair mixtur irb approv asa iii patient receiv sevofluran either ono n oair n use zeus anesthesia machin convent mode use lmin fgf fdo min follow hypox guard limit test min express total fgf lmin fdo fgffdo combin lmin fgf o use min return baselin fio start next combin sequenc studi patient receiv oair n twice patient receiv ono n examin effect decreas uptak time result three group earli ono late ono oair group fgffdofio relationship examin overal fgffdofio relationship three group similar lmin fgf group fio decreas one patient occur within min least one patient lmin oair group lmin late ono oair group fio decreas one patient current hypox guard system reliabl prevent hypox fio ono oair mixtur particular lmin

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