Efficiency of breathing systems A and D in the Carden Ventmasta ventilator

We have compared the efficiency of the enclosed Magill attachment (System A) and the co-axial System D (Bain) in the Carden Ventmasta ventilator using both systems, each under five different ventilatory conditions, in each of five anaesthetized patients. Efficiency was assessed in terms of the effective alveolar ventilation as a fraction of the fresh gas flow. For System A, efficiency increased from a mean of 0.37 when the total ventilation was only 50% of the fresh gas flow, to a mean of 0.74 when ventilation was 2.3 times the fresh gas flow. The efficiency was substantially and significantly less with System D: 75% of that for System A at the smaller total ventilation (95% CI 65-85%) and 65% at the larger (95% CI 59-71%). A critical examination is made of conflicting definitions and terminology of the efficiency of breathing systems.