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Continuous tracheal gas insufflation can wash out CO<jats:sub>2<\/jats:sub> from dead space and might also have an impact on O<jats:sub>2<\/jats:sub> and water vapor transport. The objective of this bench study is to test the impact of instrumental dead space on the transport of CO<jats:sub>2<\/jats:sub>, O<jats:sub>2<\/jats:sub>, and water vapor and the ability of continuous tracheal gas insufflation to remedy this problem during small tidal volume ventilation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A test\u2010lung located in an incubator at 37\u00b0C was ventilated with pressure levels needed to reach different tidal volumes from 1.5\u00a0to 5\u2009mL. End\u2010tidal CO<jats:sub>2<\/jats:sub> at the test\u2010lung exit, O<jats:sub>2<\/jats:sub> concentration, and relative humidity in the test\u2010lung were measured for each tidal volume with and without a 0.2\u2009L\/min continuous tracheal gas insufflation flow.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>CO<jats:sub>2<\/jats:sub> clearance was improved by continuous tracheal gas insufflation allowing a 28%\u201344% of tidal volume reduction. With continuous tracheal gas insufflation, time to reach desired O<jats:sub>2<\/jats:sub> concentration was reduced from 20% to 80% and relative humidity was restored. These results are inversely related to tidal volume and are particularly critical below 3\u2009mL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>For the smallest tidal volumes, reduction of instrumental dead space seems mandatory for CO<jats:sub>2<\/jats:sub>, O<jats:sub>2<\/jats:sub>, and water vapor transfer. Continuous tracheal gas insufflation improved CO<jats:sub>2<\/jats:sub> clearance, time to reach desired O<jats:sub>2<\/jats:sub> concentration and humidification of airways and, thus, may be an option to protect lung development.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ppul.26353","type":"journal-article","created":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T06:34:32Z","timestamp":1676356472000},"page":"1514-1519","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Instrumental dead space: A glass ceiling for extremely low birth weight preterm infants? 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