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The multiple inert gas elimination technique (MIGET)

Intensive Care Medicine volume 34, pages 994–1001 (2008)Cite this article

Abstract

This brief review centers on the multiple inert gas elimination technique (MIGET). This technique, developed in the 1970s, measures the pulmonary exchange of a set of six different inert gases dissolved together in saline (or dextrose) and infused intravenously. It then uses those measurements to compute the distribution of ventilation/perfusion ratios that best explains the exchange of the six gases simultaneously. MIGET is based on the very same mass-conservation principles underlying the classic work of Rahn and Fenn and of Riley and coworkers in the 1950s, which defines the relationship between the ventilation/perfusion ratio and the alveolar and capillary partial pressures of any gas. After a brief history of MIGET, its principles are laid out, its information content is explained, and its limitations are described. It is noted that in addition to quantifying ventilation/perfusion inequality and pulmonary shunting, MIGET can identify and quantify diffusion limitation of O2 exchange, when present, as well as explain the contributions of extrapulmonary influences such as inspired O2 concentration, ventilation, cardiac output, Hb concentration/P50, body temperature and acid/base state on arterial oxygenation. An overview of the technical details of implementing MIGET is given, and the review ends with potential future applications.

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References

  1. West JB (2008) Pulmonary pathophysiology – the essentials. Lippincott Williams & Wilkins, Baltimore

    Google Scholar 

  2. Wagner PD, Saltzman HA, West JB (1974) Measurement of continuous distributions of ventilation–perfusion ratios: theory. J Appl Physiol 36:588–599

    PubMed  CAS  Google Scholar 

  3. Wagner PD, Naumann PF, Laravuso RB (1974) Simultaneous measurement of eight foreign gases in blood by gas chromatography. J Appl Physiol 36:600–605

    PubMed  CAS  Google Scholar 

  4. Wagner PD, Laravuso RB, Uhl RR, West JB (1974) Continuous distributions of ventilation–perfusion ratios in normal subjects breathing air and 100% O2. J Clin Invest 54:54–68

    PubMed  Article  CAS  Google Scholar 

  5. Evans JW, Wagner PD (1977) Limits on VA/Q distributions from analysis of experimental inert gas elimination. J Appl Physiol 42:889–898

    PubMed  CAS  Google Scholar 

  6. Rahn H, Fenn WO (1955) A graphical analysis of the respiratory gas exchange. American Physiological Society, Washington, DC

    Google Scholar 

  7. Riley RL, Cournand A (1949) “Ideal” alveolar air and the analysis of ventilation/perfusion relationships in the lung. J Appl Physiol 1:825–847

    PubMed  CAS  Google Scholar 

  8. Riley RL, Cournand A (1951) Analysis of factors affecting partial pressures of oxygen and carbon dioxide in gas and blood of lungs: theory. J Appl Physiol 4:77–101

    PubMed  CAS  Google Scholar 

  9. Briscoe WA (1959) A method for dealing with data concerning uneven ventilation of the lung and its effects on blood gas transfer. J Appl Physiol 14:291–298

    PubMed  CAS  Google Scholar 

  10. King TKC, Briscoe WA (1967) Bohr integral isopleths in the study of blood gas exchange in the lung. J Appl Physiol 22:659–674

    PubMed  CAS  Google Scholar 

  11. Kety SS (1951) The theory and applications of the exchange of inert gas at the lungs and tissues. Pharmacol Rev 3:1–41

    PubMed  CAS  Google Scholar 

  12. Farhi LE (1967) Elimination of inert gas by the lungs. Respir Physiol 3:1–11

    PubMed  Article  CAS  Google Scholar 

  13. Yokoyama T, Farhi LE (1967) The study of ventilation/perfusion ratio distribution in the anesthetized dog by multiple inert gas washout. Respir Physiol 3:166–176

    PubMed  Article  CAS  Google Scholar 

  14. Lenfant C (1963) Measurement of ventilation/perfusion distribution with alveolar-arterial differences. J Appl Physiol 18:1090–1094

    PubMed  CAS  Google Scholar 

  15. Lenfant C, Okubo T (1968) Distribution function of pulmonary blood flow and ventilation/perfusion ratio in man. J Appl Physiol 24:668–677

    PubMed  CAS  Google Scholar 

  16. Wagner PD (1977) A general approach to evaluation of ventilation/perfusion ratios in normal and abnormal lungs. Physiologist 20:18–25

    PubMed  CAS  Google Scholar 

  17. Wagner PD (1981) Estimation of distributions of ventilation/perfusion ratios. Ann Biomed Eng 9:543–556

    PubMed  Article  CAS  Google Scholar 

  18. Wagner PD (1982) Calculation of the distribution of ventilation/perfusion ratios from inert gas elimination data. Fed Proc 41:136–139

    PubMed  CAS  Google Scholar 

  19. Hammond MD, Hempleman SC (1987) Oxygen diffusing capacity estimates derived from measured VA/Q distributions in man. Respir Physiol 69:129–147

    PubMed  CAS  Article  Google Scholar 

  20. West JB (1969) Ventilation/perfusion inequality and overall gas exchange in computer models of the lung. Respir Physiol 7:88–110

    PubMed  Article  CAS  Google Scholar 

  21. Young I, Mazzone RW, Wagner PD (1980) Identification of functional lung unit in the dog by graded vascular embolization. J Appl Physiol Respirat Environ Exercise Physiol 49:132–141

    CAS  Google Scholar 

  22. Wagner PD, López FA (1984) Gas chromatography techniques in respiratory physiology. In: Otis AB (ed) Techniques in the life sciences. Elsevier Ireland, Co Clare, Ireland, pp 403/1–403/24

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Authors and Affiliations

  1. Division of Physiology, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, Dept. 0623A, CA 92093-0623A, La Jolla, USA

    Peter D. Wagner

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  1. Peter D. Wagner
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Correspondence to Peter D. Wagner.

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Wagner, P.D. The multiple inert gas elimination technique (MIGET). Intensive Care Med 34, 994–1001 (2008). https://doi.org/10.1007/s00134-008-1108-6

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  • DOI: https://doi.org/10.1007/s00134-008-1108-6

Keywords

  • Ventilation/perfusion inequality
  • Shunt
  • Alveolar–capillary diffusion limitation
  • Hypoxemia
  • Hypercapnia
  • Inert gases