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Fresh gas requirements of an enclosed afferent reservoir breathing system during controlled ventilation in children.

An enclosed afferent reservoir breathing system (EAR) designed by Ohmeda was evaluated during anaesthesia with controlled ventilation in 104 healthy children. Carbon dioxide production and arterial carbon dioxide tension were measured in 12 children in order to determine the proportion of fresh gas (VF) involved in gas exchange. When the ratio of minute volume ventilation to fresh gas flow (VE:VF) exceeded 1.5, fractional utilization of fresh gas with the EAR was 0.92. This value and values of carbon dioxide production obtained from 43 children were used to derive a simple formula relating fresh gas flow requirements to body weight. The formula, VF = 0.6 x weight 0.5, was assessed in 49 children weighing 10-70 kg. The mean end-tidal partial pressure of carbon dioxide in these patients was 4.5 kPa (range 3.8-5.2 kPa). We conclude that the EAR has an efficiency of 92% in the use of fresh gas during controlled ventilation in healthy children, provided the VE:VF ratio is greater than 1.5. Under these conditions, normocapnia to mild hypocapnia was produced accurately using the formula VF = 0.6 x weight 0.5.