Lung volume assessments in normal and surfactant depleted lungs: agreement between bedside techniques and CT imaging

Albu, Gergely; Peták, Ferenc; Zand, Tristan; Hallbäck, Magnus; Wallin, Mats; Habre, Walid

doi:10.1186/1471-2253-14-64

Cited by 10 publications

(20 citation statements)

References 28 publications

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“…To optimize EELV NMBW performance, longer stabilization periods would probably have been needed which was not possible due to the aforementioned time constraints..Our previous experimental validation studies found that ELV resulted in larger values than EELV at lower PEEP levels in pigs and rabbits 3,15. Higher levels of PEEP impair lung perfusion and could potentially decrease ELV relative to EELV, but this was not observed in this study, possibly because PEEP was not increased enough to compromise lung perfusion.…”

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confidence: 67%

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Clinical and experimental validation of a capnodynamic method for end‐expiratory lung volume assessment

Öhman

Sigmundsson

Hallbäck

et al. 2020

Acta Anaesthesiol Scand

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Introduction Lung protective ventilation can decrease post‐operative pulmonary complications. The aim of this study was to evaluate a capnodynamic method estimating effective lung volume (ELV) as a proxy for end‐expiratory lung volume in response to PEEP changes in patients, healthy subjects and a porcine model. Methods Agreement and trending ability for ELV in anaesthetized patients and agreement in awake subjects were evaluated using nitrogen multiple breath wash‐out/in and plethysmography as a reference respectively. Agreement and trending ability were evaluated in pigs during PEEP elevations with inert gas wash‐out as reference. Results In anaesthetized patients bias (95% limits of agreement [LoA]) and percentage error (PE) at PEEP 0 cm H2O were 133 mL (−1049 to 1315) and 71%, at PEEP 5 cm H2O 161 mL (−1291 to 1613 mL) and 66%. In healthy subjects: 21 mL (−755 to 796 mL) and 26%. In porcines, at PEEP 5‐20 cm H2O bias decreased from 223 mL to 136 mL LoA (34‐412) to (−30 to 902) and PE 29%‐49%. Trending abilities in anaesthetized patients and porcines were 100% concordant. Conclusion The ELV‐method showed low bias but high PE in anaesthetized patients. Agreement was good in awake subjects. In porcines, agreement was good at lower PEEP levels. Concordance related to PEEP changes reached 100% in all settings. This method may become a useful trending tool for monitoring lung function during mechanical ventilation, if findings are confirmed in other clinical contexts.

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confidence: 67%

“…Trending was reliable, although scattered, with a 100% concordance rate between ELV and EELV when PEEP was changed from 0 to 5 cm H 2 O, in line with results from our previous animal experiments. 3,15 Although bias was low, agreement between EELV and ELV was poor, as indicated by wide LoA and high PE.…”

Section: Discussionmentioning

confidence: 99%

Clinical and experimental validation of a capnodynamic method for end‐expiratory lung volume assessment

Öhman

Sigmundsson

Hallbäck

et al. 2020

Acta Anaesthesiol Scand

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“…EELV He was determined by a helium (He) MBWT (EXHALYZER D; ECO Medics AG) procedure that has been validated and described in detail in previous publications 8,10 …”

Section: Methodsmentioning

confidence: 99%

“…The He flow was then interrupted, and the washout dilution of the tracer gas was recorded. EELV He was calculated from the changes in the He concentration during the washout phase by special software, (Spiroware, V1.4.3, ECO Medics AG) as previously described 8,10 . The instrumental dead space between the capnograph and point of EELV He measurement (3.8 mL) was subtracted from the reported EELV He values.…”

Section: Methodsmentioning

confidence: 99%

End‐expiratory lung volume assessment using helium and carbon dioxide in an experimental model of pediatric capnoperitoneum

Karlsson

Fodor

Rocha

et al. 2020

Acta Anaesthesiol Scand

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Background: Capnoperitoneum during laparoscopy leads to cranial shift of the diaphragm, loss in lung volume, and risk of impaired gas exchange. Infants are susceptible to these changes and bedside assessment of lung volume during laparoscopy might assist with optimizing the ventilation. Thus, the primary aim was to investigate the monitoring value of a continuous end-expiratory lung volume (EELV) assessment method based on CO 2 dynamics (EELV CO 2) in a pediatric capnoperitoneum model by evaluating the correlation and trending ability against helium washout (EELV He). Methods: Intra-abdominal pressure (IAP) was randomly varied between 0, 6, and 12 mm Hg with CO 2 insufflation, while positive end-expiratory pressure (PEEP) levels of 3, 6, and 9 cm H 2 O were randomly applied in eight anesthetized and mechanically ventilated chinchilla rabbits. Concomitant EELV CO 2 and EELV He and lung clearance index (LCI) were obtained under each experimental condition. Results: Significant correlations were found between EELV CO 2 and EELV He before capnoperitoneum (r = .85, P < .001), although increased IAP distorted this relationship. The negative influence of IAP was counteracted by the application of PEEP 9, which restored the correlation between EELV CO 2 and EELV He and resulted in 100% concordance rate between the methods regarding changes in lung volume. EELV He and LCI showed a curvilinear relationship, and an EELV He of approximately 20 mL kg −1 , determined with a receiver operating characteristic curve, was associated with near-normal LCI values. Conclusion: In this animal model of pediatric capnoperitoneum, reliable assessment of changes in EELV based on EELV CO 2 requires an open lung strategy, defined as EELV above approximately 20 mL kg −1. | 1107 KARLSSON et AL. How to cite this article: Karlsson J, Fodor GH, dos Santos Rocha A, et al. End-expiratory lung volume assessment using helium and carbon dioxide in an experimental model of pediatric capnoperitoneum.

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“…26 This specific pattern of breathing is achieved by an additional software of the Servo-i ventilator that creates 5 consecutive alterations in inspiratory/expiratory ratio (1:2 to 1.5:1) by varying the inspiratory pause. 27 Airflow and expired CO 2 are measured by the ordinary Y-piece flow sensor and a main stream CO 2 transducer. Flow and CO 2 data from Servo-i are exported, via the RS232 port, to a laptop with a special designed software application written in Matlab (Mathworks, Natick, MA).…”

Section: Measurement Of Effective Lung Volume and Pbfmentioning

confidence: 99%

Cardiorespiratory Alterations Following Acute Normovolemic Hemodilution in a Pediatric and an Adult Porcine Model: A Prospective Interventional Study

Albu

Sottas²,

Dolci³

et al. 2018

Anesthesia &Amp; Analgesia

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Lung volume assessments in normal and surfactant depleted lungs: agreement between bedside techniques and CT imaging

Cited by 10 publications

References 28 publications

Clinical and experimental validation of a capnodynamic method for end‐expiratory lung volume assessment

Clinical and experimental validation of a capnodynamic method for end‐expiratory lung volume assessment

End‐expiratory lung volume assessment using helium and carbon dioxide in an experimental model of pediatric capnoperitoneum

Cardiorespiratory Alterations Following Acute Normovolemic Hemodilution in a Pediatric and an Adult Porcine Model: A Prospective Interventional Study

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