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Tidal Volume Accuracy During Anesthesia
with Dräger Devices
This review focuses on varying levels of ventilation performance
identified in three peer-reviewed studies:
– Volume Controlled Ventilation (British Journal of Anaesthesia)
– Pressure Controlled Ventilation (Anesthesia & Analgesia)
– Manual Ventilation (Anaesthesia, the official journal of
the Association of Anaesthetists)
D-7755-2019
SUMMARY STUDY #1 – BRITISH JOURNAL OF ANAESTHESIA: DELIVERY
Different anesthesia companies provide diverse technologies OF TIDAL VOLUME FROM FOUR ANESTHESIA VENTILATORS
that deliver different levels of accuracy. As a result, it is DURING VOLUME-CONTROLLED VENTILATION
important to look beyond specifications and also consider Tidal volume (Vt) must be accurately delivered by
the potential real-life clinical impact of the anesthesia anesthesia ventilators in volume-controlled ventilation mode
workstation. for lung-protective ventilation to be effective. This peer-
reviewed bench study showed the impact of fresh gas flow
and lung mechanics on the delivery of tidal volume across
VOLUME
four anesthesia ventilation technologies.
PRESSURE
MAN/SPONT ≤5% >5 to ≤10% >10%
C ON T ROL Aisys™ 16 (4.9%) 115 (35.5%) 193 (59.6%)
Flow-i™ 116 (36.1%) 204 (63.6%) 1 (0.3%)
Piston ventilator Independent peer Accurate delivery of
reviewed studies tidal volume Primus® 323 (99.7%) 1 (0.3%) 0 (0%)
Zeus 126 (79.2%) 33 (20.8%) 0 (0%)
Three independent peer-reviewed studies have P-value (X ² test) <0.0001
demonstrated performance differences between bellows
and piston ventilation technologies, as well as the devices’ Results and Potential Clinical Impact
respective APL valves. While each study specifically In short, the study found that the GE Aisys™ bellow-in-box
focused on performance in one mode of ventilation (i.e., ventilator had the highest rate of volume measurement
Volume Control, Pressure Control, or Manual), the basic error. In almost 60% of all measurements for the bellow-
conclusions were: in-box ventilator, the volume error was >10%. The E-Vent
piston ventilator used in Primus and Atlan as well as the
(1) the Dräger piston ventilator delivered the highest turbine ventilator used in Perseus and Zeus anesthesia
degree of accuracy in Volume Control Ventilation, devices had the lowest rate of volume error in the high
(2) fresh gas flow had a significant effect on range (0% of measurements were >10% volume error).
tidal volume (Vt) during Pressure Control Ventilation Furthermore, 99.7% of all measurements for the piston
in the GE Aestivia™ bellows ventilator, and ventilator were <5% volume error. The study concluded
(3) non-linear pressure behavior was observed with the that under the experimental conditions, the volume error
GE Aisys CS²™ APL valve, while near linear pressure differed significantly between the four anesthesia ventilators
behavior was observed with the Dräger APL valve. tested.¹
02 | ANESTHESIA VENTILATION AND AIRWAY PRESSURE LIMITING (APL) VALVE TECHNOLOGY
STUDY #2 – ANESTHESIA & ANALGESIA: HIGHER FRESH Results and Potential Clinical Impact
GAS FLOW RATES DECREASE TIDAL VOLUME DURING The study found that the APL valve of the GE Aisys
PRESSURE CONTROL VENTILATION CS²™ shows non-linear behavior at all fresh gas flows,
The purpose of the study was to determine if FGF rates with a sudden increase of airway pressures and TVinsp
have an effect on expiratory Vt during pressure control followed by a decrease of TVinsp with further closure of
ventilation. Since small changes in Vt have a greater the APL valve, unlike the Dräger Fabius APL valve, which
impact on neonates and infants, the study was designed demonstrated nearly linear pressure and volume behavior
to reflect an infant’s lungs. The study collected data using at all fresh gas flows.
two bellows-in-box ventilators: GE Aestiva 5™ and GE
Avance CS²™. These laboratory findings support anesthetists’ subjective
clinical experience of difficulties in adjusting and
Results and Potential Clinical Impact maintaining airway pressure and TVinsp during bag
The study found that when the GE Aestevia 5™ was set at ventilation using the GE Aisys CS²™. On the GE Aisys
1 L/min, the percentage decrease of Vt comparing the CS²™ the study found that (a) airway pressure and
1 L/min FGF rate with 6, 10 and 15 L/min rates was TVinsp do not increase between 0 cmH2O and 8 cmH2O
27%, 65%, and 79% respectively. When the RR was APL valve levels, but suddenly increase with further
decreased to 10 breaths/min, the percentage decrease minimal closure of the APL valve, (b) airway pressures
of Vt for the same FGF rates was 23%, 68.5%, and considerably exceed set APL-valve pressures, (c) TVinsp
80%, respectively. The study concluded that at higher decreases with further closure of the APL valve and (d)
FGF rates, an inadvertent level of PEEP is developed TVinsp increases with the opening of the APL valve. As
by the flow resistance of the ventilator relief valve that is quoted in the study, “We conclude that the performance
not recognized by the ventilator. In turn, less change in of the GE Aisys CS²™ APL valve does not allow safe bag-
pressure is needed to reach the set inspiratory pressure, assisted ventilation of a patient’s lungs.”³
resulting in lower Vt delivery at higher FGF rates.²
1. https://academic.oup.com/bja/article/110/6/1045/245775
2. h
ttps://journals.lww.com/anesthesia-analgesia/Fulltext/2017/05000/
STUDY #3 – ANESTHESIA, THE OFFICIAL JOURNAL OF Higher_Fresh_Gas_Flow_Rates_Decrease_Tidal_Volume.25.aspx
ASSOCIATION OF ANAESTHETISTS: PERFORMANCE OF 3. https://onlinelibrary.wiley.com/doi/pdf/10.1111/anae.13689
ADJUSTABLE PRESSURE-LIMITING (APL) VALVES IN TWO
PDF 10577 | 20.08-7 | AAA | Subject to modifications | © 2020 Drägerwerk AG & Co. KGaA
DIFFERENT MODERN ANESTHESIA MACHINES
This study reviewed the performance of the APL valves
of the GE Aisys CS²™ and Dräger Fabius anesthesia
machines during closure and opening from 1-20 and from
20-1 cmH2O, using standardized experimental baby and
adolescent patient lung models.
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