Anaes Cases · Anaesthetic ventilators
Collapsed standing bellows — circuit disconnect
The hot case — the collapsed standing (ascending) bellows is the classic sign of a circuit disconnect or a major leak. Switch to the hand ventilation, find and fix the disconnect, confirm the ventilation by the capnograph, and guard against the awareness.
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Target exams
ANZCAFRCAABAEDAIC
Prompt
During a long case under controlled ventilation, the standing bellows suddenly collapses to the bottom and does not refill. The peak pressure is low and the capnograph is flat. Manage.
Presentation
Two hours into a prolonged bowel surgery under the controlled ventilation, the standing bellows suddenly falls to the bottom of its chamber and does not rise. The ventilator alarm sounds (the low pressure, the low minute volume). The capnograph trace is flat. The saturation is 97 per cent and falling slowly. The surgeon is operating.[25138359]
References2ShowHide
- [2]Coisel Y, et al. How to choose an anesthesia ventilator? Ann Fr Anesth Reanim, 2014.PMID 25138358
- [25138359]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.