A compact closed-circuit gas exchange monitor (GEM) was built for measurement of oxygen consumption (VO2) in ventilated infants. The GEM includes a ventilator-driven slave bellows, a CO2 scrubber, one-way valves to ensure unidirectional flow, and tubing to complete the small-volume low-compliance system, which fits easily between the ventilator (VENT) and the endotracheal tube (ETT). Oxygen consumption is measured by volume loss from a spirometer attached by a one-way valve. Pressure is monitored at the airway, and the VENT is adjusted to attain the desired pressure pattern. The system was leak tested by placing a 3-kg weight on the spirometer bell (continuous positive airway pressure=20 cm H2O) and then ventilating with peak inspiratory pressures (PIP) of 60 cm H2O without leak. Bench testing for accuracy of volume loss was checked by ventilating the device into another calibrated spirometer and achieving equal volumes. First, four rabbits were studied to determine the range of ventilator backup rates (BUR=0 to 60), inspiratory times (IT=.2 to .6 seconds), and airway pressures (up to 40/8 cm H2O) attainable by this device. Then six fasted rabbits weighing 2.2 to 4.0 kg were anesthetized with a ketamine-rompun mixture, underwent tracheostomy, and were placed on a pressure VENT. The BUR was set at 20/min and the IT at .5 seconds. The GEM was placed between the VENT and the ETT, and the PIP was adjusted to maintain PaCO2 between 30 and 40 torr, eliminating spontaneous respiration. Oxygen consumption was measured at five-minute intervals for one hour. Leak testing was performed before and after the 60-minute study period. Mean VO2 varied from 3.5 to 8.9 mL/kg/min and correlated inversely with weight in kilograms. The SD ranged from 0.06 to 0.3. This safe, simple, closed-circuit unit provides accurate, reproducible assessment of VO2 in a ventilated neonate model over a wide range of VENT settings commonly used in neonatal intensive care.
All Science Journal Classification (ASJC) codes
- Pediatrics, Perinatology, and Child Health