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A K Sethis EORCAPS-2009
Breathing System
Eliminate CO2
Requirements of
Breathing System
Requirements of
A Breathing System
Conservation of heat
Light weight
History
Unidirectional flow:
a.
Non rebreathing systems.
Unidirectional flow
Circle system with absorber.
Bi-directional flow:
a) Afferent reservoir systems.
Mapleson A
Mapleson B
Mapleson C
Lacks system.
B) Enclosed afferent reservoir systems
Millers (1988)
c) Efferent reservoir systems
Mapleson D
Mapleson E
Mapleson F
Bains system
d) Combined systems
Humphrey ADE
Bi-directional flow
To and Fro system.
Open System
Insufflation
Open
Semi-open
No direct contact
Semi-closed
No rebreathing of gases
Closed
Open Systems
Semi-open Systems
Anesthetic dripped
Concentration varies
Environmental pollution
Reservoir
No rebreathing
Bi-Directional Flow
Semi Closed
Mapleson Breathing System
No clear separation of inspired and expired gases rebreathing will occur when inspiratory flow exceeds FGF
Composition of inspired mixture will depend upon
rebreathing
Elimination of CO2
Classification
Elimination of CO2
Bi-Directional Flow
parameters like
A through E
It is the volume of the breathing system from the patient-end to the point up
to which, to and fro movement of expired gas takes place
Mapleson A
Mapleson Classification
Reservoir bag
Corrugated tubing
Magill Circuit
It differs from the other Mapleson systems in that fresh gas does not
enter the system near the patient connection but enters at the other
APL valve
FGI
Patient connection
Functional Analysis
Mapleson A
Functional Analysis
Mapleson A with Control Ventilation
Disadvantage
this mode the variable orifice is kept widely open to allow free communication
to the atmosphere
In
In
function similarly
pressure thus developed closes the expiratory valve squeezes the enclosed
afferent reservoir and the patient gets ventilated
this system should function efficiently during spontaneous and
controlled ventilation with a FGF equivalent to alveolar ventilation
The
Hence
corrugated tubing
Mapleson D
Modified Mapleson D
Bain 1972
The fresh gas supply tube runs coaxially inside the corrugated tubing
and ends at the point where the fresh gas would enter if the classic
Mapleson D form were used
The outer tube is clear so that the inner tube can be inspected
Bain Circuit
Bain System
Spontaneous ventilation
Controlled ventilation
infants <10kg
2 L/m
adult > 60 kg
70 ml/kg/min
Ability of scavenging
Mapleson E
Disadvantage
Mapleson E
Mapleson F
Hazards
Advantage
In
Resistance
Easy
system
Changes
Compression
& compliance volume losses are less than with the circle
hyperthermia
Combined System
Humphrey ADE
Two reservoirs, one in the afferent limb and the other in the
work of breathing
Prevent rebreathing
efferent limb
Paediatric Circuit
Questions ?
Expiratory valve
In ERS
Bain Circuit
Coaxial length
1.8 meter
7 mm
22 mm
Resistance
<0.7 cm H2O
CO2 elimination
FGF utilization
In spontaneous respiration to
prevent rebreathing the
Mapleson A requires flow rate