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The Humphrey ADE system: evaluation in paediatric use
C E Orlikowski1, M C Ewart, R M Bingham
1Department of Anaesthesia, Hospital for Sick Children, London.
Insights
The Humphrey ADE breathing system effectively supported pediatric patients during mechanical ventilation and spontaneous breathing. It performed similarly to T-piece circuits, with specific fresh gas flow recommendations for optimal use.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Respiratory Support Devices
Background:
- The Humphrey ADE single lever parallel form breathing system is a device used in pediatric respiratory support.
- Evaluating its performance in mechanically ventilated and spontaneously breathing children is crucial for clinical application.
Purpose of the Study:
- To assess the efficacy and safety of the Humphrey ADE breathing system in pediatric patients.
- To compare its performance against established breathing circuits like the Jackson-Rees modification of Ayre's T-piece.
Main Methods:
- The study involved 17 children requiring mechanical ventilation and 10 spontaneously breathing children.
- Performance was evaluated in different modes: controlled ventilation (E mode) and hand ventilation (A mode).
- Fresh gas flow (FGF) rates and end-tidal partial pressure of carbon dioxide (PETCO2) were measured.
Main Results:
- During controlled ventilation (E mode), the ADE system's performance was comparable to the T-piece circuit with standard or weight-based FGF.
- In hand ventilation (A mode), mean PETCO2 was 5.3 kPa, and no rebreathing occurred in spontaneously breathing patients at 3 L/min FGF.
- Rebreathing during spontaneous breathing in A mode began at 124 ml/kg/min FGF.
Conclusions:
- The Humphrey ADE circuit demonstrated satisfactory performance across all evaluated modes in pediatric patients.
- For controlled ventilation (E mode), FGF adjustment should follow T-piece circuit recommendations.
- For hand ventilation (A mode), a FGF exceeding 3 L/min is advised.
Abstract:
The Humphrey ADE single lever parallel form breathing system was evaluated in 17 children whose lungs were ventilated mechanically, mean age 28 (range 9-58) months, weight 13.3 (8.3-18.0) kg and in 10 spontaneously breathing children, age 50.7 (18-99) months and weight 17.5 (10.9-24.3) kg. During controlled ventilation in the E mode, the ADE behaved in a manner similar to the Jackson-Rees modification of Ayre's T-piece with the fresh gas flows (FGF) set either according to weight or at a standard 3 litre min-1. After 5 min hand ventilation in the A mode with FGF 3 litre min-1 the mean end-tidal partial pressure of carbon dioxide was 5.3 (SD 0.8) kPa (range 4.1-7.7 kPa). Whilst breathing spontaneously in the A mode, no patient experienced rebreathing at FGF 3 litre min-1; rebreathing started at 124 (31.6) ml kg-1 min-1. The ADE circuit performed satisfactorily in all three modes. During controlled ventilation in the E mode, FGF should be adjusted according to the standard formulae recommended for the T-piece circuit. During hand ventilation in the A mode, an FGF greater than 3 litre min-1 should be used.