Abstract
Purpose
The aim of our study was to evaluate volumetric capnography (VCap) in the differentiation between chronic obstructive pulmonary disease (COPD) patients and normal subjects.
Patients and Methods
Thirty-nine healthy male volunteers and 60 male COPD patients were enrolled. Regression equations between VCap indices and age, weight, height, and tidal volume in healthy volunteers were established by stepwise regression analysis. Predicted normal values of VCap indices in COPD patients were calculated. A paired t test was used to compare the difference between observed and predicted values for VCap indices in COPD patients. Receiver operating characteristic (ROC) curve analysis was used to evaluate the power of each VCap index alone in differentiating COPD patients and normal subjects. The power of the combination of VCap indices was assessed by discriminant analysis.
Results
All regression equations were significant (P < 0.01) as were the differences between the observed and predicted normal VCap indices in COPD patients (P < 0.001). ROC curve analysis showed that the volume between 25 and 50 % of F CO2et (Vm25-50), slope of Phase II (dC2/dV), and slope of Phase III (dC3/dV) were valuable predictors. Nearly all (90.9 %) subjects were correctly classified by discriminant analysis.
Conclusion
Vm25-50, dC2/dV, or dC3/dV alone are valuable for differentiating COPD patients and normal subjects, but more powerful are the combinations of Vm25-50, dC2/dV, and dC3/dV, the ratio of dC2/dV to dC3/dV (SR23), dead space according to the Bohr method (VDB), and dead space according to the Wolff and Brunner methods (PIE).
This is a preview of subscription content, access via your institution.


References
Cerveri I, Corsico AG, Grosso A, Albicini F, Ronzoni V, Tripon B et al (2013) The rapid FEV(1) decline in chronic obstructive pulmonary disease is associated with predominant emphysema: a longitudinal study. COPD 10(1):55–61. doi:10.3109/15412555.2012.727920
Mohamed Hoesein FA, Zanen P, Sachs AP, Verheij TJ, Lammers JW, Broekhuizen BD (2012) Spirometric thresholds for diagnosing COPD: 0.70 or LLN, pre- or post-dilator values? COPD 9(4):338–343. doi:10.3109/15412555.2012.667851
Aitken RSC-KA (1928) On the fluctuation in the composition of the alveolar air during the respiratory cycle in muscular excercise. J Physiol 65:389–411
Gube M, Brand P, Conventz A, Ebel J, Goeen T, Holzinger K et al (2009) Spirometry, impulse oscillometry and capnovolumetry in welders and healthy male subjects. Respir Med 103(9):1350–1357. doi:10.1016/j.rmed.2009.03.011
Kelsey JE, Oldham EC, Horvath SM (1962) Expiratory carbon dioxide concentration curve. A test of pulmonary function. Dis Chest 41:498–503
Scheffzek S, Mosing M, Hirt R, Iff I, Moens Y (2012) Volumetric capnography curves as lung function test to confirm bronchoconstriction after carbachol challenge in sedated dogs. Res Vet Sci 93(3):1418–1425. doi:10.1016/j.rvsc.2012.04.010
Wolff G, Brunner JX (1984) Series dead space volume assessed as the mean value of a distribution function. Int J Clin Monit Comput 1(3):177–181
Tusman G, Sipmann FS, Borges JB, Hedenstierna G, Bohm SH (2011) Validation of Bohr dead space measured by volumetric capnography. Intensive Care Med 37(5):870–874. doi:10.1007/s00134-011-2164-x
Fletcher R, Jonson B, Cumming G, Brew J (1981) The concept of deadspace with special reference to the single breath test for carbon dioxide. Br J Anaesth 53(1):77–88
Moreira MM, Terzi RG, Cortellazzi L, Falcao AL, Moreno H Jr, Martins LC et al (2010) Volumetric capnography: in the diagnostic work-up of chronic thromboembolic disease. Vasc Health Risk Manag 6:317–319
Moreira MM, Terzi RG, Pereira MC, Grangeia Tde A, Paschoal IA (2008) Volumetric capnography as a noninvasive diagnostic procedure in acute pulmonary thromboembolism. Jornal brasileiro de pneumologia 34(5):328–332
Moreira MM, Terzi RG, Paschoal IA, Martins LC, Oliveira EP, Falcao AL (2010) Thrombolysis in massive pulmonary embolism based on the volumetric capnography. Arq Bras Cardiol 95(4):e97–e99
Moreira MM, Terzi RG, Carvalho CH, de Oliveira Neto AF, Pereira MC, Paschoal IA (2009) Alveolar dead space and capnographic variables before and after thrombolysis in patients with acute pulmonary embolism. Vasc Health Risk Manag 5(1):9–12
Veronez L, Moreira MM, Soares ST, Pereira MC, Ribeiro MA, Ribeiro JD et al (2010) Volumetric capnography for the evaluation of pulmonary disease in adult patients with cystic fibrosis and noncystic fibrosis bronchiectasis. Lung 188(3):263–268. doi:10.1007/s00408-009-9213-z
Blanch L, Lucangelo U, Lopez-Aguilar J, Fernandez R, Romero PV (1999) Volumetric capnography in patients with acute lung injury: effects of positive end-expiratory pressure. Eur Respir J 13(5):1048–1054
Kallet RH, Daniel BM, Garcia O, Matthay MA (2005) Accuracy of physiologic dead space measurements in patients with acute respiratory distress syndrome using volumetric capnography: comparison with the metabolic monitor method. Respir Care 50(4):462–467
Romero PV, Lucangelo U, Lopez Aguilar J, Fernandez R, Blanch L (1997) Physiologically based indices of volumetric capnography in patients receiving mechanical ventilation. Eur Respir J 10(6):1309–1315
Sinha P, Soni N (2012) Comparison of volumetric capnography and mixed expired gas methods to calculate physiological dead space in mechanically ventilated ICU patients. Intensive Care Med 38(10):1712–1717. doi:10.1007/s00134-012-2670-5
Siobal MS, Ong H, Valdes J, Tang J (2013) Calculation of physiologic dead space: comparison of ventilator volumetric capnography to measurements by metabolic analyzer and volumetric CO2 monitor. Respir Care 58(7):1143–1151. doi:10.4187/respcare.02116
Tusman G, Scandurra A, Bohm SH, Suarez-Sipmann F, Clara F (2009) Model fitting of volumetric capnograms improves calculations of airway dead space and slope of phase III. J Clin Monit Comput 23(4):197–206. doi:10.1007/s10877-009-9182-z
Tusman G, Gogniat E, Bohm SH, Scandurra A, Suarez-Sipmann F, Torroba A et al (2013) Reference values for volumetric capnography-derived non-invasive parameters in healthy individuals. J Clin Monit Comput 27(3):281–288. doi:10.1007/s10877-013-9433-x
Krauss B, Deykin A, Lam A, Ryoo JJ, Hampton DR, Schmitt PW et al (2005) Capnogram shape in obstructive lung disease. Anesth Analg 100(3):884–888. doi:10.1213/01.ANE.0000146520.90393.91 table of contents
Steiss JO, Rudloff S, Landmann E, Zimmer KP, Lindemann H (2008) Capnovolumetry: a new tool for lung function testing in children with asthma. Clin Physiol Funct Imaging 28(5):332–336. doi:10.1111/j.1475-097X.2008.00815.x
Herholz C, Straub R, Moens Y, Busato A (2001) Statistical shape analysis of volumetric capnograms: evaluation of a new approach for the assessment of pulmonary function in horses with chronic obstructive pulmonary disease. J Vet Med A Physiol Pathol Clin Med 48(2):75–84
Romero PV, Rodriguez B, de Oliveira D, Blanch L, Manresa F (2007) Volumetric capnography and chronic obstructive pulmonary disease staging. Int J Chron Obstruct Pulmon Dis 2(3):381–391
The Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Global Initiative for Chronic Obstructive Lung Disease 2013. Available from: http://www.goldcopd.org/guidelines-global-strategy-for-diagnosis-management.html
Fowler WS (1948) Lung function studies; the respiratory dead space. Am J Physiol 154(3):405–416
Tusman G, Sipmann FS, Bohm SH (2012) Rationale of dead space measurement by volumetric capnography. Anesth Analg 114(4):866–874. doi:10.1213/ANE.0b013e318247f6cc
Fletcher R. The single breath test for carbon dioxide: R. Fletcher; 1986
Furey ML, Nugent AC, Speer AM, Luckenbaugh DA, Hoffman EM, Frankel E et al (2012) Baseline mood-state measures as predictors of antidepressant response to scopolamine. Psychiatry Res 196(1):62–67. doi:10.1016/j.psychres.2012.01.003
Kars AH, Bogaard JM, Stijnen T, de Vries J, Verbraak AF, Hilvering C (1997) Dead space and slope indices from the expiratory carbon dioxide tension-volume curve. Eur Respir J 10(8):1829–1836
Mosing M, Iff I, Hirt R, Moens Y, Tusman G (2012) Evaluation of variables to describe the shape of volumetric capnography curves during bronchoconstriction in dogs. Res Vet Sci 93(1):386–392. doi:10.1016/j.rvsc.2011.05.014
Koulouris NG, Latsi P, Dimitroulis J, Jordanoglou B, Gaga M, Jordanoglou J (2001) Noninvasive measurement of mean alveolar carbon dioxide tension and Bohr’s dead space during tidal breathing. Eur Respir J 17(6):1167–1174
Astrom E, Niklason L, Drefeldt B, Bajc M, Jonson B (2000) Partitioning of dead space—a method and reference values in the awake human. Eur Respir J 16(4):659–664
Acknowledgments
We thank Wei Zheng, Yingmin Wang, Liqing Xu, and Cailiu Huang for their technical guidance and help with data collection. We also thank Hua Yang, Weiju Zhou, Shanshan Li, Zhijun Tang, Linxuan Wang, Guoping Deng, Xiaolong Gu, and Xuanbo Chen for the selection of subjects.
Conflict of interest
This study was supported by the Chinese Medical Association. The authors report no conflicts of interest. The authors alone are responsible for the creation and content of this paper. Funded by Outstanding Young Medical Talents Training Project of Pudong Health Bureau of Shanghai, and Key Discipline Construction Project of Pudong Health Bureau of Shanghai.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Qi, GS., Gu, WC., Yang, WL. et al. The Ability of Volumetric Capnography to Distinguish between Chronic Obstructive Pulmonary Disease Patients and Normal Subjects. Lung 192, 661–668 (2014). https://doi.org/10.1007/s00408-014-9615-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00408-014-9615-4