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J Thorac Cardiovasc Surg 2003;125:1043-1049
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Efficiency of a gas diffuser and influence of suction in carbon dioxide deairing of a cardiothoracic wound cavity model

Peter Svenarud, MDa, Mikael Persson, MSca,b, Jan van der Linden, MD, PhDa

From the Department Cardiothoracic Surgery and Anesthesiology, Huddinge University Hospital,a and the Division of Medical Engineering, Department of Medical Laboratory Science and Technology, Karolinska Institute,b Stockholm, Sweden.

Supported by Karolinska Institute and Cardia Innovation AB, Stockholm, Sweden.

Received for publication June 14, 2002. Accepted for publication Aug 6, 2002. Address for reprints: Jan van der Linden, MD, Department of Cardiothoracic Surgery and Anesthesiology, M85, Karolinska Institute, Huddinge University Hospital, SE-141 86 Stockholm, Sweden (E-mail: jan.vanderlinden{at}thsurg.hs.sll.se).

Objective: In cardiac surgery, insufflation of carbon dioxide is used for deairing of the heart and great vessels. The aim of this study was to assess a new insufflation device for efficient deairing and to study the influence of suction.
Methods: We measured the content of remaining air at two positions in the cardiothoracic wound model. A new insufflation device, a gas diffuser, was compared with a conventional 0.25-inch tube. Carbon dioxide flow (5 and 10 L/min) and suction (0, 1.5, 10, and 25 L/min) were varied. Suction was studied in combination with the gas diffuser.
Results: With the tube the median air content in the wound model was 19.5% to 51.7% at the studied carbon dioxide flows, whereas with the gas diffuser the median air content was no greater than 1.2% at 5 L/min and no greater than 0.31% at 10 L/min (P < .001). When suction of 1.5 L/min was applied, the median air content in the model remained low (<=1.0%) at both carbon dioxide flows. With suction of 10 L/min the median air content was still low (<=0.50%) at a simultaneous carbon dioxide flow of 10 L/min. Conversely, suction of 25 L/min caused a marked increase in air content at carbon dioxide flows of both 5 and 10 L/min (P < .001).
Conclusions: This study demonstrated that the most efficient deairing (<=1% remaining air) in a cardiothoracic wound model was provided by a gas diffuser at a carbon dioxide flow of 10 L/min. A conventional 0.25-inch tube failed to do so (19.5%-51.7% remaining air). Additional suction deteriorated air displacement with the gas diffuser when suction exceeded carbon dioxide inflow.






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