RE: Bain or lack? Thoughts please?

Meow1950 — Fri, 23 Nov 2018 13:21:05 GMT

So informative, thank you so much

RE: Bain or lack? Thoughts please?

Susanna Taylor — Fri, 23 Nov 2018 02:16:38 GMT

It is possible that those patients are struggling with the resistance caused by the valves and 'soda lime' and this is causing the rebreathing. Well done for spotting it.

It is worth considering if these patients are lean weight over 10kg, or fat and therefore over 10kg but with thoracic muscles of under 10kg! Just a thought

Anyhow, it is useful to have a middle system.

A Lack would be preferred due to the lower flow rates, as you mention, and also as it can provide a little warmer and humidified gas if low flow rates are used (using capnograph to adjust) as there can be some anatomical dead space rebreathing (i.e. no CO2). Thats the theory anyway.

Re IPPV, because of the positive pressure, the resistance problems with a circle are overcome in these borderline patients and so you should be able to ventilate them without any rebreathing issues.

Also, its worth noting, that if you turn flow rates up high enough with a Lack, you can also IPPV ok. But i would only do this with a capnograph to be sure of no rebreathing.

1 thing to note about IPPV with a circle during CPR is that you must be sure to get rid of as much iso/sevo as possible before you start. This means disconnecting and using the O2 flush to flush lots before connecting again. Some places prefer to use a Bain in CPR to sideline this, but I appreciate that is not suitable if you have a 4.5Lmin flow rate limit. Another option would be to invest in an ambu bag that you can connect to the oxygen for these situations. Sorry, that was going off on an tangent

Let me know if any questions or above doesn't make sense