{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T20:42:23Z","timestamp":1775508143122,"version":"3.50.1"},"reference-count":21,"publisher":"BMJ","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Dis Child Fetal Neonatal Ed"],"accepted":{"date-parts":[[2011,10,14]]},"published-print":{"date-parts":[[2012,5]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The authors previously showed that 48% of infants &lt;800 g were ventilated with tidal volume (VT) &lt; dead space (DS) using volume guarantee (VG) ventilation. Here, The authors sought to confirm those findings under the rigorous conditions of a bench study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design and methods<\/jats:title>\n                  <jats:p>The authors measured the time to wash out CO2 from a 45-ml test lung using end-tidal CO<jats:sub>2<\/jats:sub> monitor (ETCO<jats:sub>2<\/jats:sub>). The test lung was filled with 100% CO<jats:sub>2<\/jats:sub>, then ventilated using VG at VT ranging from DS+2 ml to DS\u20131.5 ml. With ventilation, ETCO<jats:sub>2<\/jats:sub> declined exponentially as CO<jats:sub>2<\/jats:sub> was washed out, the rate being proportional to VT \u2013 effective instrumental DS. The time from initiation of ventilation to threshold of accurate detection was determined in triplicate.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Halving the theoretical \u2018alveolar ventilation\u2019 (DS+2 ml to DS+1 ml) only increased the elimination time by 26%, not the 100%, as predicted by conventional physiology. CO<jats:sub>2<\/jats:sub> washout was less efficient, but still occurred even at VT=DS and VT=DS\u20131.5 ml. Halving the theoretical \u2018alveolar ventilation\u2019 by decreasing respiratory rate from 80 to 40 breaths\/min only increased elimination time by 35%, not 100%, as predicted by conventional physiology. Twenty minutes of continuous positive airway pressure prior to ventilation did not alter the elimination time, verifying that CO<jats:sub>2<\/jats:sub> did not diffuse or leak out of the test lung. Size of the endotracheal tube (ETT; 2.5, 3.0 and 3.5 mm) flow rate (4, 6 and 10 l\/min) and inspiratory time (0.25 vs 0.35 s) did not affect the results.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Contrary to conventional physiology, effective CO<jats:sub>2<\/jats:sub> elimination appears to be possible with VT&lt;DS even at conventional rates. With small ETT a spike of fresh gas likely penetrates through the DS, rather than pushing it ahead.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/archdischild-2011-300647","type":"journal-article","created":{"date-parts":[[2011,11,19]],"date-time":"2011-11-19T20:25:40Z","timestamp":1321734340000},"page":"F188-F192","source":"Crossref","is-referenced-by-count":21,"title":["Effective ventilation at conventional rates with tidal volume below instrumental dead space: a bench study"],"prefix":"10.1136","volume":"97","author":[{"given":"Martin","family":"Keszler","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Brugada","family":"Montaner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kabir","family":"Abubakar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2011,11,18]]},"reference":[{"key":"2025090515132369000_97.3.F188.1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.1091"},{"key":"2025090515132369000_97.3.F188.2","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.20063"},{"key":"2025090515132369000_97.3.F188.3","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.10458"},{"key":"2025090515132369000_97.3.F188.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2005.00695.x"},{"key":"2025090515132369000_97.3.F188.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2006.05.013"},{"key":"2025090515132369000_97.3.F188.6","doi-asserted-by":"crossref","unstructured":"Wheeler K Klingenberg C McCallion N . Volume-targeted versus pressure-limited ventilation in the neonate. Cochrane Database of Systematic Reviews 2010, 11: CD003666.","DOI":"10.1002\/14651858.CD003666.pub3"},{"issue":"(1)","key":"2025090515132369000_97.3.F188.7","first-page":"107","article-title":"Volume Guarantee Ventilation","volume-title":"Clinics in Perinatology: Update on Surfactant and Mechanical Ventilation","volume":"34","author":"Keszler","year":"2007"},{"key":"2025090515132369000_97.3.F188.8","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1164\/ajrccm.162.6.9906112","article-title":"Tidal volumes for ventilated infants should be determined with a pneumotachometer placed at the endotracheal tube","volume":"162","author":"Cannon","year":"2000","journal-title":"Am J Respir Crit Care Med"},{"key":"2025090515132369000_97.3.F188.9","doi-asserted-by":"publisher","DOI":"10.1542\/peds.105.1.112"},{"key":"2025090515132369000_97.3.F188.10","doi-asserted-by":"crossref","unstructured":"Greenough A Dimitriou G Prendergast M . Synchronized mechanical ventilation for respiratory support in newborn infants. Cochrane Database Syst Rev 2008;1:CD000456","DOI":"10.1002\/14651858.CD000456.pub3"},{"key":"2025090515132369000_97.3.F188.11","unstructured":"Volume-targeted versus pressure-limited ventilation in the neonate. Cochrane Database of Syst Rev 2010; 3: CD003666."},{"key":"2025090515132369000_97.3.F188.12","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.20954"},{"key":"2025090515132369000_97.3.F188.13","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-005-2711-4"},{"key":"2025090515132369000_97.3.F188.14","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000155789.52984.B7"},{"key":"2025090515132369000_97.3.F188.15","doi-asserted-by":"publisher","DOI":"10.1542\/peds.110.3.529"},{"key":"2025090515132369000_97.3.F188.16","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.20363"},{"key":"2025090515132369000_97.3.F188.17","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.20667"},{"key":"2025090515132369000_97.3.F188.18","doi-asserted-by":"crossref","first-page":"S24","DOI":"10.1097\/00003246-199422091-00002","article-title":"Gas flow and mixing in the airways","volume":"22","author":"Pedley","year":"1994","journal-title":"Crit Care Med"},{"key":"2025090515132369000_97.3.F188.19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1152\/ajplegacy.1915.38.1.1","article-title":"The respiratory dead space","volume":"38","author":"Henderson","year":"1915","journal-title":"Am J Physiol"},{"key":"2025090515132369000_97.3.F188.20","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1152\/jappl.1954.7.1.27","article-title":"Alveolar ventilation at very low tidal volumes","volume":"7","author":"Briscoe","year":"1954","journal-title":"J Appl Physiol"},{"key":"2025090515132369000_97.3.F188.21","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1213\/00000539-198206000-00001","article-title":"The role of conducting airways in gas exchange during high-frequency ventilation\u2013a clinical and theoretical analysis","volume":"61","author":"Eriksson","year":"1982","journal-title":"Anesth Analg"}],"container-title":["Archives of Disease in Childhood - Fetal and Neonatal Edition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/archdischild-2011-300647","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T22:56:07Z","timestamp":1757112967000},"score":1,"resource":{"primary":{"URL":"https:\/\/fn.bmj.com\/lookup\/doi\/10.1136\/archdischild-2011-300647"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,11,18]]},"references-count":21,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2012,4,17]]},"published-print":{"date-parts":[[2012,5]]}},"alternative-id":["10.1136\/archdischild-2011-300647"],"URL":"https:\/\/doi.org\/10.1136\/archdischild-2011-300647","relation":{},"ISSN":["1359-2998","1468-2052"],"issn-type":[{"value":"1359-2998","type":"print"},{"value":"1468-2052","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,11,18]]}}}