Thorac Cardiovasc Surg 2004; 52
DOI: 10.1055/s-2004-816866

Which is the optimal device for carbon dioxide de-airing of the cardiothoracic wound and how should it be positioned?

M Persson 1, 2, P Svenarud 2, J van der Linden 2
  • 1Department of Cardiothoracic Surgery & Anesthesiology, Huddinge University Hospital
  • 2Division of Medical Engineering, Department of Medical Laboratory Science & Technology, Karolinska Institute, Stockholm, Sweden

Objectives: To compare recently described insufflation devices for efficient carbon dioxide (CO2) de-airing of the cardiothoracic wound, and to determine the importance of their position.

Material and Methods: The devices were tested in a full-size torso with a cardiothoracic wound, and in 10 patients undergoing cardiac surgery. Insufflation of CO2 into the wound cavity at 2.5, 5, 7.5, and 10 l/min with a multi-perforated catheter, and a 2.5-mm tube with either a gauze sponge or a gas-diffuser of polyurethane foam at its end. The devices were tested when positioned at the level of the wound opening and 5cm below, and after exposure to fluid.

Results: De-airing was assessed by measuring the remaining air content at the right atrium. With the multi-perforated catheter, the gauze sponge, and the gas-diffuser, the lowest median air content in the torso was 8.4%, 2.5%, and 0.3%, respectively (p<0.001), when positioned inside the wound cavity. When exposed to fluid, the gauze sponge and the multi-perforated catheter immediately became inefficient (70% and 96% air, respectively), whereas the gas-diffuser remained efficient (0.4% air). During surgery the gas-diffuser provided a median air content of 1.0% at 5 l/min, and 0.7% at 10 l/min.

Conclusions: For efficient de-airing, CO2 has to be delivered from within the wound cavity. The gas-diffuser was the most efficient device. In contrast to a gas-diffuser, a multi-perforated catheter or a gauze sponge is unsuitable for CO2 de-airing since they will stop functioning when they get wet in the wound.