• Abraham Rosenbaum, Christopher Kirby, and Peter H Breen.
• Department of Anesthesiology, University of California-Irvine, Orange, 92868, USA.
• Anesthesiology. 2004 Jun 1;100(6):1427-37.

BackgroundThe authors have developed a new clinical bymixer that bypasses a constant fraction of gas flow through a mixing arm. A separate bymixer was interposed in the expiratory and inspiratory limbs of the ventilation circuit to measure mixed gas fractions. By utilizing nitrogen conservation, the clinical bymixer allows the determination of airway carbon dioxide elimination (VCO2) and oxygen uptake (VO2), whenever basic expired flow and gas monitoring measurements are used for the patient. Neither an expiratory exhaust gas collection bag nor expensive, complex equipment are needed. This study tested the accuracy of airway bymixer-flow measurements of VCO2 and VO2 in a new bench apparatus.MethodsThe authors compared airway bymixer-flow measurements of VCO2 and VO2 over a range of reference values generated by ethanol combustion in a new metabolic lung simulator, which was ventilated by a volume-cycled respirator. An airway humidity and temperature sensor permitted standard temperature and pressure, dry, correction of airway VCO2 and VO2.ResultsBymixer-flow airway measurements of VCO2 and VO2 correlated closely (R2 = 0.999 and 0.998, respectively) with the stoichiometric values generated by ethanol combustion. Limits of agreement for VCO2 and VO2 were 0.1 +/- 4.7 and 1.1 +/- 5.7%, respectively. The average (+/- SD) percent error for airway VCO2 (compared with the stoichiometric value) was 0.1 +/- 2.4%. The same error for airway VO2 was 1.1 +/- 2.9%.ConclusionsThe new clinical bymixer, plus basic expired flow and gas fraction measurements, generated clinically accurate determinations of VCO2 and VO2. These measurements are helpful in the assessment of metabolic gas exchange in the critical care unit. In contrast to using the gas collection bag or complex metabolic monitor, the bymixer should measure mixed gas concentrations in the inspired or expired limb of the common anesthesia circle ventilation circuit.

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