Summary
The oxygen washin method has been shown to be a practical way to measure functional residual capacity (FRC) in the intensive care unit. The ventilator oxygen concentration is increased and measurements of respiratory flow and oxygen concentration at the mouth are made with the patient monitoring system. No additional personnel, bedside equipment or ventilator attachments are required. A feasibility study was performed to determine if this method could be used to estimate a continuous distribution of ventilation with respect to ventilation to volume ratio\({{\dot V_A } \mathord{\left/ {\vphantom {{\dot V_A } V}} \right. \kern-\nulldelimiterspace} V}\). Due to gas mixing in the ventilator, the inspired oxygen fraction does not increase instantaneously to its new value. An equation was derived which models the lung as 50 discrete compartments and accounts for the transient change in mean inspired oxygen fraction. A digital computer simulation demonstrated good distribution recovery for one and two mode ventilation distributions. Continuous distributions were computed for four post cardiac surgery patients at four levels of positive end expiratory pressure (PEEP). In these patients a linear increase in the amount of ventilation in the normal\({{\dot V_A } \mathord{\left/ {\vphantom {{\dot V_A } V}} \right. \kern-\nulldelimiterspace} V}\) range occurred with increasing PEEP, i.e., slow and fast spaces tended to move centrally toward a more normal\({{\dot V_A } \mathord{\left/ {\vphantom {{\dot V_A } V}} \right. \kern-\nulldelimiterspace} V}\) range. At zero PEEP 26% of the ventilation occurred in the normal range and this increased to 49% at 15 PEEP. Dead space fraction was poorly estimated and spurious modes occurred in the high\({{\dot V_A } \mathord{\left/ {\vphantom {{\dot V_A } V}} \right. \kern-\nulldelimiterspace} V}\) range.
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Mitchell, R.R., Wilson, R.M. & Sierra, D. ICU monitoring of ventilation distribution. International Journal of Clinical Monitoring and Computing 2, 199–206 (1986). https://doi.org/10.1007/BF01884351
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DOI: https://doi.org/10.1007/BF01884351