What is the preferred bellows design, ascending or descending?
The disadvantages of the descending bellows are unrecognized disconnection (due to their design, they may fill even when disconnected from the patient), and also collection of exhaled humidity in bellows (risking infection and lessening delivered tidal volume). To tell if a bellows is ascending (“standing”) or descending (“hanging”), look at them during expiration (remember- ascend and descend have “e”s in them). The modern type is ascending. Only one current machine, the Anestar, uses a hanging bellows, but incorporates capnography and sensors to detect failure of the bellows to fill, both of which may lessen unrecognized disconnects.
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