Comparison in Spontaneous Ventilation of the Maxima with the Humphrey ADE Breathing System and between Four Methods for Detecting Rebreathing

Abstract

An enclosed efferent, afferent reservoir breathing system (Maxima, Life Air Pty Ltd), being valveless, was compared to a simple afferent reservoir system (Humphrey ADE, A mode), having a valve, by assessing fresh gas flow (V̇F) requirements, with respect to ventilation (V̇E), that prevents rebreathing in volunteers, awake and breathing spontaneously. The results are recorded in terms of the quotient V̇F/V̇E associated with the onset of rebreathing. At the same time four clinical methods for assessing rebreathing were evaluated from the perspective of suitability for practical application during anaesthesia. No significant difference was found in the VF requirements between the ADE and Maxima breathing systems with respective values obtained for the quotient VF/VE of 0.80 and 0.77. Our findings showed that the method of sampling carbon dioxide (CO2) at the outflow of the efferent limb of the patient connector (eliminated CO2 method) in both afferent reservoir systems provided the highest flow rate and most reliable indication for detecting potential or actual rebreathing, when attempting to minimize VF. It provides no additional deadspace or resistance to gas flow, and has the advantage of being the only qualitative method that is reliable for the purpose of detecting the onset of rebreathing.