Reise Katherine, Macartney Jason, La Richard, Jerath Angela, Slessarev Marat, Cuthbertson Brian H, Ganesan Saptharishi Lalgudi, McKinnon Nicole K
Department of Critical Care The Hospital for Sick Children.
Occupational Health and Safety The Hospital for Sick Children.
Can J Respir Ther. 2024 Jun 18;60:95-102. doi: 10.29390/001c.118513. eCollection 2024.
The use of volatile anesthetic agents in the paediatric intensive care unit (PICU) is experiencing increased interest since the availability of the miniature vapourizing device. However, the effectiveness of scavenging systems in the presence of humidifiers in the ventilator circuit is unknown.
We performed a bench study to evaluate the effectiveness of the Deltasorb® scavenging system in the presence of isoflurane and active humidity by simulating both infant and child ventilator test settings. A total of four ventilators were set to ventilate test lungs, all with active humidity and a Deltasorb scavenging canister collecting exhaled ventilation gas. Two ventilators also had isoflurane delivered using the Anesthesia Conserving Device- small (ACD®-S) on the inspiratory limb (also called alternative ventilator configuration). We performed instantaneous measurements of isoflurane and continuous sampling with passive badges to measure average environmental exposure over a test period of 6.5 hours. Scavenging canisters were returned to the company, where desorption analysis showed the volume of water and isoflurane captured in each canister.
Both instantaneous point sampling and diffusive sampling results were below the occupational exposure limit confirming safety. The canisters collected both isoflurane and a portion of the water vapour delivered; the percentage of captured water and isoflurane collected in infants was higher than the child ventilator test settings.
The tested scavenging configuration was effective in maintaining a safe working environment with active humidity and inspiratory limb (alternative) ventilator configuration of the the miniature vapourizing device.
自微型汽化装置问世以来，挥发性麻醉剂在儿科重症监护病房（PICU）的应用越来越受到关注。然而，在呼吸机回路中存在加湿器的情况下，清除系统的有效性尚不清楚。
我们进行了一项实验台研究，通过模拟婴儿和儿童呼吸机测试设置，评估Deltasorb®清除系统在异氟烷和主动加湿情况下的有效性。总共设置了四台呼吸机用于通气测试肺，均采用主动加湿，并使用一个Deltasorb清除罐收集呼出的通气气体。两台呼吸机还在吸气支路上使用麻醉节省装置小型（ACD®-S）输送异氟烷（也称为替代呼吸机配置）。我们对异氟烷进行了即时测量，并使用被动徽章进行连续采样，以测量6.5小时测试期内的平均环境暴露量。清除罐被送回公司，在那里进行解吸分析，以显示每个罐中捕获的水量和异氟烷量。
即时点采样和扩散采样结果均低于职业暴露限值，证实了安全性。清除罐收集了异氟烷和一部分输送的水蒸气；婴儿组收集的捕获水和异氟烷的百分比高于儿童呼吸机测试设置。
经过测试的清除配置在主动加湿和微型汽化装置的吸气支路（替代）呼吸机配置下，能有效维持安全的工作环境。
