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Published in: Intensive Care Medicine 5/2011

01-05-2011 | Physiological and Technical Notes

Validation of Bohr dead space measured by volumetric capnography

Authors: Gerardo Tusman, Fernando Suarez Sipmann, Joao B. Borges, Göran Hedenstierna, Stephan H. Bohm

Published in: Intensive Care Medicine | Issue 5/2011

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Abstract

Purpose

Bohr’s dead space (VDBohr) is commonly calculated using end-tidal CO2 instead of the true alveolar partial pressure of CO2 (PACO2). The aim of this work was to validate VDBohr using PACO2 derived from volumetric capnography (VC) against VDBohr with PACO2 values obtained from the standard alveolar air formula.

Methods

Expired gases of seven lung-lavaged pigs were analyzed at different lung conditions using main-stream VC and multiple inert gas elimination technique (MIGET). PACO2 was determined by VC as the midpoint of the slope of phase III of the capnogram, while mean expired partial pressure of CO2 (PeCO2) was calculated as the mean expired fraction of CO2 times the barometric minus the water vapor pressure. MIGET estimated expired CO2 output (VCO2) and PeCO2 by its V/Q algorithms. Then, PACO2 was obtained applying the alveolar air formula (PACO2 = VCO2/alveolar ventilation).

Results

We found close linear correlations between the two methods for calculating both PACO2 (r = 0.99) and VDBohr (r = 0.96), respectively (both p < 0.0001). Mean PACO2 from VC was very similar to the one obtained by MIGET with a mean bias of −0.10 mmHg and limits of agreement between −2.18 and 1.98 mmHg. Mean VDBohr from VC was close to the value obtained by MIGET with a mean bias of 0.010 ml and limits of agreement between −0.044 and 0.064 ml.

Conclusions

VDBohr can be calculated with accuracy using volumetric capnography.
Appendix
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Literature
1.
go back to reference Bohr C (1891) Über die Lungeatmung. Skand Arch Physiol 2:236–238 Bohr C (1891) Über die Lungeatmung. Skand Arch Physiol 2:236–238
2.
go back to reference Haldane JS, Priestley JG (1905) The regulation of the lung-ventilation. J Physiol 32:225–266PubMed Haldane JS, Priestley JG (1905) The regulation of the lung-ventilation. J Physiol 32:225–266PubMed
3.
go back to reference Krogh A, Lindhard J (1913) On the average composition of the alveolar air and its variations during the respiratory cycle. J Physiol 47:431–445 Krogh A, Lindhard J (1913) On the average composition of the alveolar air and its variations during the respiratory cycle. J Physiol 47:431–445
4.
go back to reference Fowler WS (1948) Lung function studies II. The respiratory dead space. Am J Physiol 154:405–416PubMed Fowler WS (1948) Lung function studies II. The respiratory dead space. Am J Physiol 154:405–416PubMed
5.
go back to reference Aitken RS, Clark-Kennedy AE (1928) On the fluctuation in the composition of the alveolar air during the respiratory cycle in muscular excercise. J Physiol 65:389–411PubMed Aitken RS, Clark-Kennedy AE (1928) On the fluctuation in the composition of the alveolar air during the respiratory cycle in muscular excercise. J Physiol 65:389–411PubMed
6.
go back to reference Fletcher R, Jonson B (1981) The concept of deadspace with special reference to the single breath test for carbon dioxide. Br J Anaesth 53:77–88PubMedCrossRef Fletcher R, Jonson B (1981) The concept of deadspace with special reference to the single breath test for carbon dioxide. Br J Anaesth 53:77–88PubMedCrossRef
7.
go back to reference Breen PH, Mazumdar B, Skinner SC (1996) Comparison of end-tidal PCO2 and average alveolar expired PCO2 during positive end-expiratory pressure. Anesth Analg 82:368–373PubMedCrossRef Breen PH, Mazumdar B, Skinner SC (1996) Comparison of end-tidal PCO2 and average alveolar expired PCO2 during positive end-expiratory pressure. Anesth Analg 82:368–373PubMedCrossRef
8.
go back to reference Tusman G, Scandurra A, Böhm 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 23:197–206PubMedCrossRef Tusman G, Scandurra A, Böhm 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 23:197–206PubMedCrossRef
9.
go back to reference Kallet RH, Daniel BM, Garcia O, Matthay MA (2005) Accuracy of physiologic dead space measurements in patients with ARDS using volumetric capnography: comparison with the metabolic monitor method. Respir Care 50:462–467PubMed Kallet RH, Daniel BM, Garcia O, Matthay MA (2005) Accuracy of physiologic dead space measurements in patients with ARDS using volumetric capnography: comparison with the metabolic monitor method. Respir Care 50:462–467PubMed
10.
go back to reference West JB (1969) Ventilation-perfusion inequality and overall gas exchange in computer models of the lung. Respiration Physiol 7:88–110CrossRef West JB (1969) Ventilation-perfusion inequality and overall gas exchange in computer models of the lung. Respiration Physiol 7:88–110CrossRef
11.
go back to reference Wagner PD, Saltzman HA, West JB (1974) Measurement of continuous distributions of ventilation-perfusion ratios: theory. J Appl Physiol 36:588–599PubMed Wagner PD, Saltzman HA, West JB (1974) Measurement of continuous distributions of ventilation-perfusion ratios: theory. J Appl Physiol 36:588–599PubMed
12.
go back to reference Dubois AB, Britt AG, Fenn WO (1951) Alveolar CO2 during the respiratory cycle. J Appl Physiol 4:535–548 Dubois AB, Britt AG, Fenn WO (1951) Alveolar CO2 during the respiratory cycle. J Appl Physiol 4:535–548
13.
go back to reference Jordanoglou J, Koulouris N, Kyroussis D, Rapakoulias P, Vassalos P, Madianos J (1995) Measurement of effective alveolar carbon dioxide tension during spontaneous breathing in normal subjects and patients with chronic airways obstruction. Thorax 50:240–244PubMedCrossRef Jordanoglou J, Koulouris N, Kyroussis D, Rapakoulias P, Vassalos P, Madianos J (1995) Measurement of effective alveolar carbon dioxide tension during spontaneous breathing in normal subjects and patients with chronic airways obstruction. Thorax 50:240–244PubMedCrossRef
14.
go back to reference Enghoff H (1938) Volumen inefficax. Bemerkungen zur Frage des schädlichen Raumes. Uppsala Läkareforen Forhandl 44:191–218 Enghoff H (1938) Volumen inefficax. Bemerkungen zur Frage des schädlichen Raumes. Uppsala Läkareforen Forhandl 44:191–218
15.
go back to reference Riley RL, Cournand A (1949) Ideal alveolar air and the analysis of ventilation-perfusion relationships in the lungs. J Applied Physiol 1:825–847 Riley RL, Cournand A (1949) Ideal alveolar air and the analysis of ventilation-perfusion relationships in the lungs. J Applied Physiol 1:825–847
16.
go back to reference Suter PM, Fairley HB, Isenberg MD (1975) Optimum end-expiratory airway pressure in patients with acute pulmonary failure. N Engl J Med 292:284–289PubMedCrossRef Suter PM, Fairley HB, Isenberg MD (1975) Optimum end-expiratory airway pressure in patients with acute pulmonary failure. N Engl J Med 292:284–289PubMedCrossRef
17.
go back to reference Hedenstierna G, Sandhagen B (2006) Assessing dead space. A meaningful variable? Minerva Anestesiol 72:521–528PubMed Hedenstierna G, Sandhagen B (2006) Assessing dead space. A meaningful variable? Minerva Anestesiol 72:521–528PubMed
Metadata
Title
Validation of Bohr dead space measured by volumetric capnography
Authors
Gerardo Tusman
Fernando Suarez Sipmann
Joao B. Borges
Göran Hedenstierna
Stephan H. Bohm
Publication date
01-05-2011
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 5/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-011-2164-x

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