Mapleson classification of breathing system


Breathing system refers to the components that connect the airway of the patient to the anaesthesia machine. This machine is used to dispense a controlled composition of a gas mixture to the patient and allows controlled, spontaneous or assisted respiration. Thus, it delivers the gas to the patient, removes the expired gas and also controls the humidity and temperature of the mixture that is to be dispensed. It can also provide ports for airway pressure, gas sampling, volume and flow monitoring.

Mapleson was able to analyse five different arrangements of the components, known as the Mapleson system. This consists of fresh gas flow, a breathing tube, a mask, a reservoir bag and an expiratory valve. These were designated from A to E and the system F was added later on by Wills et al.

The characteristics of an ideal breathing system include simplicity, safety and a reasonable cost. It should be able to deliver the intended inspired gas mixture and permit controlled, spontaneous or assisted breathing in all age groups. Moreover, it should allow efficient gas flow and easily eliminate CO2 and waste gases. It should be able to protect patients from barotraumas and dead space must be minimal. Warming and humidification of inspired gases must be possible, and it would be ideal if it were sturdy, compact and light weight. It must also have low resistance, minimal length, and maximum internal diameter and should not have sharp curves or sudden changes in diameters.

The components of a breathing tube and their features are listed below:
Breathing tubes: These are large bores, usually corrugated tubes as this increases flexibility and resistance to kinking. They are made of rubber or plastic and clear plastic tubes are lightweight and low resistance. They may act as a reservoir in certain systems. They also have some distensibility but not enough so that excessive pressures do not develop in the circuit.

Adjustable pressure limiting valve: This is also called the scavenger valve, relief valve, pop-off valve, over-spill valve, exhaust valve and expiratory valve. This valve allows exhaled waste gases and fresh gas flows to leave the breathing system, in case the pressure within it exceeds the opening pressure of the valve.

Reservoir bag: This is made of antistatic rubber or plastic and accommodates fresh gas flow during expiration, and acts as a reservoir available for use in next inspiration. It also acts as a monitor of the ventilator y pattern of the patient. Bain circuits, connectors and adapters are also important parts of the system.

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