Ventilator Circuit Setup

Filter Placement & Humidification Types

2021.7

“SINGLE LIMB” CIRCUITS*

Heated Wire
&GtiZeLeatLumidißGatiSn Air Intake Exhalation
Valve Pressure
** Sense Line
Exhalation Expiratory Limb
Drive Line

Inspiratory Limb
Heated
**Air Intake BV Filter may
Bacterial Wire
be recommended for some Viral (BV) Filter
devices and may require menu Heated Wire
settings changes. When intake
BV filter is in use, BV filter be- Heater Controller
tween the vent and inspiratory Humidißer
limb may not be needed.

Heat Moisture Exchanger Filter (HMEF) Exhalation

** Air Intake Valve Pressure
Expiratory Limb Sense Line
Exhalation Drive Line

HMEFs must always be

placed between the circuit Inspiratory Limb
wye and the endotracheal
tube. They should not be
used at the ventilator or Bacterial HMEF
exhalation valve.
Viral Filter

Heat Moisture Exchanger (HME) Exhalation

’:ßlterF]*xLalatiSn:alZe Air Intake
Valve
** Pressure
When using an HME, the Expiratory Limb
expiratory BV filter should
Sense Line
ideally be placed either
Exhalation
at the exhalation valve (as Drive Line
shown) or at the takeoff of
the expiratory limb from
the Wye (not shown).
This illustration shows a
slightly different type of
expiratory valve than the Inspiratory Limb
others on this page. This
has no implication for the Bacterial
location of HMEs or filters. HME
Viral Filter

Heat Moisture Exchanger Exhalation

(BVF by HME) Air Intake Valve
** Pressure
When unable to place Exhalation Sense Line
the expiratory BV filter in Expiratory Limb
the expiratory limb due to
Drive Line
hoses glued to the Wye or
expiratory valve, it may be
placed at the wye in series
with the HME. CAUTION:
this increases dead space Inspiratory Limb
& resistance. Review
manufacturer’s reported
dead-space & resistance
as tidal volume or pressure
support level may require Bacterial
HME
adjustment to ensure adequate ventilation. Viral Filter

* The term ‘single limb’ is a commonly used misnomer to describe the circuits shown
here. These circuits do have a second (expiratory) limb, and thus may be considered
functionally similar to ‘dual limb circuits’
 2021.7

DUAL LIMB CIRCUITS

Heated Wire Bacterial
&GtiZeLeatLumidißGatiSn Viral Filter Heated Wire
Controller
Expiratory Limb

Inspiratory Limb
Heated
Wire

Heater
Humidißer

Heat Moisture Exchanger (HME)

Expiratory Limb
Wye

Inspiratory Limb

Bacterial HME
Viral Filter

Heat Moisture Exchange Filter (HMEF)

Expiratory Limb
Wye

Inspiratory Limb

Bacterial
Viral Filter HMEF

END TIDAL CO2 PLACEMENT

Sidestream CO2 Sidestream CO2 Mainstream CO2
Sampling HMEF with Sampling HME and Monitoring HME
integrated sampling port Bacterial Viral Filter

HMEF Bacterial HME HME

Viral Filter
Deadspace and resistance are increased by the addition of any filters or other adapters, including
end tidal CO2. Read manufacturers’’ specifications to quantify potential impact on ventilator strategy.
CPAP/NIPPV Circuit Setup
Mask types & filter placement
Always check manufacturer’s recommendations to determine if your device, circuit, and mask combination requires an additional anti-asphyxia valve (not shown) 2021.7

Dual Limb Circuit + Non-Vented Mask

(Exhalation valve in the circuit) • Because this setup has an
expiratory valve at or in the ventilator
Non-vented (not shown), a non-vented mask
HMEF Mask must be used for CPAP/NIPPV

Expiratory Limb • See Figure “Ventilator Circuit Setup”

for alternative humidification & filter
setups. An HMEF is shown here
but may not be the optimal setup
depending on local resources.

• Of note, the addition of filters

Inspiratory Limb between the circuit Wye and the
Wye patient introduce dead space.

“Single Limb” Circuit + Non-Vented Mask

(Exhalation valve in the circuit) • The term ‘single limb’ circuit is a
commonly used misnomer when
Non-vented
Exhalation referring to the type of circuit shown
Pressure Mask here. The setup shown has a short
Exhalation Valve
Sense Line expiratory limb and expiratory valve
Drive Line Expiratory Limb
and functions similarly to a dual limb
circuit.

• Because this setup has an expiratory

valve, a non-vented mask must be
used for CPAP/NIPPV

• See Figure “Ventilator Circuit Setup”

Inspiratory Limb HMEF for alternative humidification & filter
Wye setups.

True Single Limb Circuit + Vented Mask

(No exhalation valve) • The ’true’ single limb circuit is
commonly found in home CPAP/
Expiratory Flow
Expiratory Flow NIPPV machines and has no
expiratory valve.
• Exhaled breath must leave through
intentional leak ports - in this setup a
Vented vented mask is used
Mask
• The BV filter in this scenario protects
the patient from a potentially con-
taminated device/circuit but does
Inspiratory Limb
not protect personnel from potential-
ly infectious aerosolized particles in
Bacterial the exhaled gas.
Viral Filter

True Single Limb Circuit + e

L ak Adapter + Non-Vented Mask
(No exhalation valve) • This ’true’ single limb circuit is
commonly found in home CPAP/
NIPPV machines and has no
Non-vented expiratory valve.
Mask
Expiratory Flow
• Exhaled breath must leave through
intentional leak ports - in this setup,
Fixed Leak a non-vented mask is used and the
Adapter leak occurs via a specializedßxed
leak adapter in the circuit.
• Either a bacterial viral filter (if active
heated humidification is being used)
Inspiratory Limb or HMEF (if no active heated
humidification) should be placed be-
tween the leak adapter & the patient.
HMEF

CPAP - continuous positive airway pressure

NIPPV - non-invasive positive pressure ventilation (e.g. bilevel positive airway pressure)
 2021.7

Bag valve resuscitator setup

Self-Inating Air-inlet
Reservoir Bag & Pressure PEEP valve
Bag Release Valve

Oxygen Inlet CO2 Sampling

& Tubing Line
Bacterial
Viral Filter

HMEF may be considered over a

bacterial viral filter if duration of
use on the bag valve resuscitator
is anticipated to be prolonged.

In-line suction catheter setup

Bacterial
Viral Filter
Expiratory Limb Wye

This illustration shows the location

of the in-line suction catheter in
relation to the patient circuit. There
are other potential configurations Inspiratory Limb
not shown here, but in all, the in-
line suction catheter is placed on In-line Suction
the endotracheal tube. Catheter