Evaluation of a CO2 partial rebreathing functional residual capacity measurement method for use during mechanical ventilation
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There is a need for an automated bedside functional residual capacity (FRC) measurement method that does not require a step change in inspired oxygen fraction. Such a method can be used for patients who require a high inspired oxygen fraction to maintain arterial oxygenation and for patients ventilated using a circle breathing system commonly found in operating rooms, which is not capable of step changes in oxygen. We developed a CO2 rebreathing method for FRC measurement that is based on the change in partial pressure of end-tidal carbon dioxide and volume of CO2 eliminated at the end of a partial rebreathing period. This study was designed to assess the accuracy and precision of the proposed FRC measurement system compared to body plethysmography and nitrogen washout FRC.
Accuracy and precision of measurements were assessed by comparing the CO2 rebreathing FRC values to the gold standard, body plethysmography FRC, in twenty spontaneously breathing volunteers. The CO2 rebreathing FRC measurements were then compared to nitrogen washout FRC in twenty intensive care patients whose lungs were mechanically ventilated. For each subject, an average value of CO2 rebreathing FRC was compared to the average gold standard method. Measurements were accepted for statistical analysis if they had been recorded from periods of stable tidal ventilation, defined as a coefficient of variation of tidal volume of <0.13.
Compared to body plethysmography, the accuracy (average error) for the CO2 rebreathing method during stable ventilation (n = 8) was 0.03 L and precision (1 standard deviation of the error) was 0.29 L (0.8 ± 7.6% of body plethysmography). During stable mechanical ventilation (n = 9), the accuracy was −0.02 L and precision was 0.26 L (−1.1 ± 12.6% of nitrogen washout).
The CO2 rebreathing method for FRC measurement provides acceptable accuracy and precision during stable ventilation compared to the gold standards of body plethysmography and nitrogen washout. The results based on periods of stable ventilation best approximate the performance of the system in the likely areas of application during controlled mechanical ventilation. Further study of the CO2 rebreathing method is needed to evaluate accuracy in a larger group of controlled mechanical ventilation patients, including patients with respiratory insufficiency and significant lung injury.
Keywordslung functional residual capacity measurement technqs monitoring intensive care
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- 1.Bikker I, Bommel J, Reis Miranda D, Bakker J, Gommers D. End-expiratory lung volume during mechanical ventilation: a comparison with reference values and the effect of positive end-expiratory pressure in intensive care unit patients with different lung conditions. Crit Care. 2008; 12: R145.Google Scholar
- 4.Heinze H, Sedemund-Adib B, Gosch UW, Eichler W. Monitoring alveolar derecruitment at bedside using functional residual capacity measurements in cardiac surgery patients. Appl Cardiopulm Pathophysiol. 2008;12:27–32.Google Scholar
- 9.Mattingley J, Holets S, Oeckler R, Stroetz R, Buck C, Hubmayr R. Sizing the lung of mechanically ventilated patients. Crit Care. 2011; 15: R60.Google Scholar
- 12.Olegard C, Sondergaard S, Houltz E, Lundin S, Stenqvist O. Estimation of functional residual capacity at the bedside using standard monitoring equipment: a modified nitrogen washout/washin technique requiring a small change of the inspired oxygen fraction. Anesth Analg. 2005;101:206–12.PubMedCrossRefGoogle Scholar
- 14.Botero M, Kirby D, Lobato EB, Staples ED, Gravenstein N. Measurement of cardiac output before and after cardiopulmonary bypass: comparison among aortic transit-time ultrasound, thermodilution, and noninvasive partial CO2 rebreathing. J Cardiothorac Vasc Anesth. 2004;18(5):563–72.PubMedCrossRefGoogle Scholar
- 15.Capek JM, Roy RJ. Noninvasive measurement of cardiac output using partial CO2 rebreathing.. IEEE Trans Biomed Eng 1988; 35(9): 653–661Google Scholar
- 17.Mead J. Volume displacement body plethysmograph for respiratory measurements in human subjects. J Appl Physiol. 1960;15:736–40.Google Scholar
- 19.Blonshine S, Foss C, Mottram C, Ruppel G, Wanger J. AARC clinical practice guideline: body plethysmography: 2001 revision and update. Respir Care. 2001;46:506–13.Google Scholar
- 20.Brewer L, Orr, J, Sherman, M, Fulcher, E, Markewitz, B. Measurement of functional residual capacity by modified multiple breath nitrogen washout for spontaneously breathing and mechanically ventilated patients. Br J Anaesth. 2011. doi:10.1093/bja/aer220.
- 21.Chiumello D, Cressoni M, Chierichetti M, Tallarini F, Botticelli M, Berto V, Mietto C, Gattinoni L. Nitrogen washout/washin, helium dilution and computed tomography in the assessment of end expiratory lung volume. Crit Care. 2008; 12: R150.Google Scholar