Bedside monitoring of lung volume available for gas exchange.

Autor: Tran MC; Nuffield Division of Anaesthetics, University of Oxford, Oxford, UK. minh.tran@chch.ox.ac.uk.; Department of Engineering Science, University of Oxford, Oxford, UK. minh.tran@chch.ox.ac.uk., Crockett DC; Nuffield Division of Anaesthetics, University of Oxford, Oxford, UK., Cronin JN; Centre for Human and Applied Physiological Sciences, King's College London, London, UK.; Department of Anaesthetics, Guy's and St. Thomas' NHS Foundation Trust, London, UK., Borges JB; Centre for Human and Applied Physiological Sciences, King's College London, London, UK., Hedenstierna G; Hedenstierna Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden., Larsson A; Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden., Farmery AD; Nuffield Division of Anaesthetics, University of Oxford, Oxford, UK., Formenti F; Nuffield Division of Anaesthetics, University of Oxford, Oxford, UK. federico.formenti@outlook.com.; Centre for Human and Applied Physiological Sciences, King's College London, London, UK. federico.formenti@outlook.com.; Department of Biomechanics, University of Nebraska, Omaha, NE, USA. federico.formenti@outlook.com.
Jazyk: angličtina
Zdroj: Intensive care medicine experimental [Intensive Care Med Exp] 2021 Jan 11; Vol. 9 (1), pp. 3. Date of Electronic Publication: 2021 Jan 11.
DOI: 10.1186/s40635-020-00364-6
Abstrakt: Background: Bedside measurement of lung volume may provide guidance in the personalised setting of respiratory support, especially in patients with the acute respiratory distress syndrome at risk of ventilator-induced lung injury. We propose here a novel operator-independent technique, enabled by a fibre optic oxygen sensor, to quantify the lung volume available for gas exchange. We hypothesised that the continuous measurement of arterial partial pressure of oxygen (PaO 2 ) decline during a breath-holding manoeuvre could be used to estimate lung volume in a single-compartment physiological model of the respiratory system.
Methods: Thirteen pigs with a saline lavage lung injury model and six control pigs were studied under general anaesthesia during mechanical ventilation. Lung volumes were measured by simultaneous PaO 2 rate of decline (V PaO2 ) and whole-lung computed tomography scan (V CT ) during apnoea at different positive end-expiratory and end-inspiratory pressures.
Results: A total of 146 volume measurements was completed (range 134 to 1869 mL). A linear correlation between V CT and V PaO2 was found both in control (slope = 0.9, R 2  = 0.88) and in saline-lavaged pigs (slope = 0.64, R 2  = 0.70). The bias from Bland-Altman analysis for the agreement between the V CT and V PaO2 was - 84 mL (limits of agreement ± 301 mL) in control and + 2 mL (LoA ± 406 mL) in saline-lavaged pigs. The concordance for changes in lung volume, quantified with polar plot analysis, was - 4º (LoA ± 19°) in control and - 9° (LoA ± 33°) in saline-lavaged pigs.
Conclusion: Bedside measurement of PaO 2 rate of decline during apnoea is a potential approach for estimation of lung volume changes associated with different levels of airway pressure.
Databáze: MEDLINE
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