How much oxygen? State of the art

Air-oxygen mixtures in circle systems

STUDY OBJECTIVE

To determine the effect of different air-O(2) mixtures and fresh gas flows (FGF) on the relationship between the delivered (F(Del)O(2)) and inspired O(2) fraction (FIO(2)) in a circle system.

STUDY DESIGN

Randomized clinical study.

SETTING

Large teaching hospital.

PATIENTS

160 ASA physical status I, II, and III patients undergoing a variety of cardiovascular procedures with general endotracheal anesthesia.

INTERVENTIONS

160 patients were randomly assigned to one of 20 groups (n = 8 each), depending on the combination of total FGF (0.5, 1, 2, 4, or 8 L/min) and air-O(2) mixture used (ratios of 4/1, 3/2, 2/3, or 1/4), corresponding to a F(Del)O(2) of 0.37, 0.53, 0.68, and 0.84. For each combination of FGF and air-O(2) mixture, FIO(2) after equilibration was compared with F(Del)O(2).

MEASUREMENTS AND MAIN RESULTS

With any air-O(2) mixture with a FGF < or = 2 L/min, FIO(2) became lower than F(Del)O(2). Because FIO(2) decreased below 0.25 after 13 and 26 minutes in the first two patients of the 4/1 0.5 L/min air-O(2) group, this study limb was terminated.

CONCLUSIONS

When using air-O(2) mixtures in a circle system, FIO(2) becomes lower than the F(Del)O(2) with FGF < or = 2 L/min. The relative proportion of O(2) in the FGF has to be increased accordingly.

Five oxygen-nitrous oxide proportioning systems compared

The majority of contemporary gas delivery modules, on anaesthetic workstations, are equipped with oxygen-nitrous oxide proportioning systems which should prevent the delivery of hypoxic gas mixtures. We investigated five modules, of two different types, using fresh gas flows ranging from 50 mL min-1 to 20 L min-1 with minimally acceptable proportions of oxygen and maximally acceptable proportions of nitrous oxide set at the flow control valves. The oxygen concentrations of the resulting gas mixtures were measured at the fresh gas outlet of the gas delivery modules. All the modules prevented the delivery of hypoxic fresh gas flows both under normal and abnormal working conditions (unequal supply of gas pressures). All systems showed increased O2 concentrations at fresh gas flows below 1 L min-1. The systems can be used with low flow anaesthesia techniques with one exception (Dameca) also with minimal flow techniques.