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Direct visualization of carbon dioxide field flooding: Optical and concentration level comparison of diffusor effectiveness


Vandenberghe, Stijn; Iseli, David; Demertzis, Stefanos (2020). Direct visualization of carbon dioxide field flooding: Optical and concentration level comparison of diffusor effectiveness. Journal of Thoracic and Cardiovascular Surgery, 159(3):958-968.

Abstract

OBJECTIVE: Carbon dioxide field flooding during open-heart surgery is intended to avoid blood-air contact, bubble formation, and embolism, and therefore potential neurologic and other ischemic complications. The inert gas is invisible, and thus its use and effectiveness are heavily debated. We intended to provide better insight in the behavior of the gas via direct concentration measurements and visualization of the gas cloud.
METHODS: A transparent rectangular model of the open thorax was created, foreseen with carbon dioxide concentration sensors in 2 locations (atrial and aortic incisions), and placed in an optical test bench that amplifies the diffraction gradients. Six different commonly used carbon dioxide diffusors (3 commercial, 3 improvised) were tested with different flow rates of gas delivery (1, 4, 7, 10 standard liter per minute [SLPM]) and combined with the application of suction.
RESULTS: The imaging reveals that commercially available diffusors generally create less turbulent flow than improvised diffusors, which is supported by the concentration measurements where improvised diffusors cannot generate a 100% carbon dioxide atmosphere at the aorta incision location. The atrial incision is easier to protect: 0% air with all commercial devices for all flow rates greater than 1 SLPM. A flow rate of 1 SLPM does not create an inert atmosphere with any device.
CONCLUSIONS: The optically observed carbon dioxide atmosphere is unstable and influenced by many factors. The device used for diffusion and the flow rate are important determinants of the maximum gas concentration that can be achieved, as is the location where this is measured.

Abstract

OBJECTIVE: Carbon dioxide field flooding during open-heart surgery is intended to avoid blood-air contact, bubble formation, and embolism, and therefore potential neurologic and other ischemic complications. The inert gas is invisible, and thus its use and effectiveness are heavily debated. We intended to provide better insight in the behavior of the gas via direct concentration measurements and visualization of the gas cloud.
METHODS: A transparent rectangular model of the open thorax was created, foreseen with carbon dioxide concentration sensors in 2 locations (atrial and aortic incisions), and placed in an optical test bench that amplifies the diffraction gradients. Six different commonly used carbon dioxide diffusors (3 commercial, 3 improvised) were tested with different flow rates of gas delivery (1, 4, 7, 10 standard liter per minute [SLPM]) and combined with the application of suction.
RESULTS: The imaging reveals that commercially available diffusors generally create less turbulent flow than improvised diffusors, which is supported by the concentration measurements where improvised diffusors cannot generate a 100% carbon dioxide atmosphere at the aorta incision location. The atrial incision is easier to protect: 0% air with all commercial devices for all flow rates greater than 1 SLPM. A flow rate of 1 SLPM does not create an inert atmosphere with any device.
CONCLUSIONS: The optically observed carbon dioxide atmosphere is unstable and influenced by many factors. The device used for diffusion and the flow rate are important determinants of the maximum gas concentration that can be achieved, as is the location where this is measured.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Cardiocentro Ticino
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Surgery
Health Sciences > Pulmonary and Respiratory Medicine
Health Sciences > Cardiology and Cardiovascular Medicine
Language:English
Date:March 2020
Deposited On:12 Jan 2021 17:42
Last Modified:13 Jan 2021 21:01
Publisher:Elsevier
ISSN:0022-5223
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1016/j.jtcvs.2019.04.040
PubMed ID:31200936

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