A reply

Abstract

We would like to thank Drs Bennett and Bingham for their interest in our work. They highlighted a section of our paper where, they claim, we mistakenly suggested that the Association of Paediatric Anaesthetists (APA) had endorsed previous guidance published by the Association of Anaesthetists of Great Britain and Ireland (AAGBI) on the re-use of breathing systems with paediatric patients. We apologise for this error, but feel that this, which was written after consultation with some our paediatric anaesthetist colleagues, highlights that there is still confusion in this area. The original guidance published by the AAGBI was that ‘In paediatric practice where the use of a filter would increase dead space and/or resistance unacceptably, filters should not be used but the breathing system should be changed between patients’[1]. The deleterious effects of the increase in deadspace [2] and resistance to gas flow [3] by adding a filter continue to be highlighted for this particularly vulnerable group of patients and reference continues to be made to the original guidance [4-6]. It could be inferred from the joint statement by Drs Bennett and Bingham that the original guidelines had not been replaced. However, we acknowledge that many anaesthetists do use paediatric breathing systems for more than one patient [7, 8], though the situation is probably different if the patient weighs less than 3 kg; perhaps there is a case to publish separate guidelines for these two groups of paediatric patients. Maybe it is worth emphasising that many manufacturers still label breathing systems intended for use with paediatric patients as ‘single-use’. An individual who re-uses such a breathing system takes on full responsibility for its safety and effectiveness [9]. Because of this, to quote Grant: ‘An injured patient does not have to prove it was your fault. You have to show that is was not your fault’[10]. The guidance on the re-use of medical device marked for single-use is therefore quite explicit. The recent discussion on the use of filters in paediatric patients arose from the work carried out for the Medicines and Healthcare products Regulatory Agency (MHRA) [11], which indicated that the performance of filters intended for use with paediatric patients was not as always as good as that of filters intended for use with adults [5]. It is perhaps worth stating that, even if the performance of filters intended for use with small infants was similar to that of adult filters when tested at lower flows, the absence of any published minimum level of performance makes interpretation of the results rather difficult. However, our study, on which Drs Bennett and Bingham commented, concentrated on another, separate, aspect; namely, how easily water can pass through different filters. We hope that our article has added to the debate on the use of these devices, and possibly help during the formulation of guidelines and policies for the use of these devices.