• K I Wheeler, C J Morley, C O F Kamlin, and P G Davis.
• Neonatal Services, Royal Women's Hospital, Cnr Grattan Street & Flemington Road, Parkville, VIC 3052, Australia. kevin.wheeler@thewomens.org.au
• Arch. Dis. Child. Fetal Neonatal Ed. 2009 Mar 1;94(2):F84-6.

BackgroundTwo unexpected observations were made during ventilation with the Dräger Babylog 8000+ in volume-guarantee mode: (a) during complete obstruction to gas flow down the endotracheal tube (ETT), positive inspiratory pressure (PIP) was reduced to half way between the maximum inflating pressure and the positive end expiratory pressure (PEEP) even though the set expired tidal volume had not been achieved; (b) an external Dräger waveform monitor may stop displaying real-time waveforms when a tube-obstructed alarm is activated.ObjectiveTo investigate these phenomena using a test lung.MethodA 50 ml Dräger test lung was attached to the ventilation circuit of a Dräger Babylog 8000+. Partial obstruction to ETT flow was induced by compressing the tubing leading to the test lung, and complete obstruction was achieved by clamping. Recordings were made from the digital output of the ventilator at 125 Hz.ResultsWhen the ETT flow was completely obstructed during VG ventilation, a constant PIP was set midway between the set maximum and PEEP. This did not happen during partial obstruction. The external waveform monitor display froze when ETT flow was completely obstructed.ConclusionsDuring complete ETT obstruction, the PIP is set to a pressure midway between maximum PIP and PEEP even if this is less than the PIP used before the obstruction. Further research is needed to evaluate whether this reduction in PIP is associated with prolongation of precipitating events.

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