Optimal management of apparatus dead space in the anesthetized infant

Michael R. King*, Jeffrey M. Feldman

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

13 Scopus citations


Mechanical ventilation of the anesthetized infant requires careful attention to equipment and ventilator settings to assure optimal gas exchange and minimize the potential for lung injury. Apparatus dead space, defined as dead space resulting from devices placed between the endotracheal tube and the Y-piece of the breathing circuit, is the primary source of dead space controlled by the clinician. Due to the small tidal volumes required by infants and neonates, it is easy to create excessive apparatus dead space resulting in unintended hypercarbia or increased minute ventilation in an effort to achieve a desirable PCO2. The goal of this review was to evaluate the apparatus that are commonly added to the breathing circuit during anesthesia care, and develop recommendations to guide the clinician in selecting apparatus that are best matched to the clinical goals and the patient's size. We include specific recommendations for apparatus that are best suited for different size pediatric patients, with a particular focus on patients <5 kg.

Original languageEnglish (US)
Pages (from-to)1185-1192
Number of pages8
JournalPaediatric anaesthesia
Issue number12
StatePublished - Dec 2017


  • capnography
  • general anesthesia
  • humidifiers
  • mechanical ventilation
  • respiratory dead space
  • respiratory physiology phenomena

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Pediatrics, Perinatology, and Child Health


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