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

Autor:	Anders Oldner, Magnus Hallbäck, Fernando Suarez Sipmann, Mats Wallin, Håkan Björne, T. Öhman, ThorirSvavar Sigmundsson, Caroline Hällsjö Sander
Rok vydání:	2020
Předmět:	Adult Male medicine.medical_specialty Anestesi och intensivvård Swine gas exchange Ventilator lung lung volume measurements Positive-Pressure Respiration Young Adult 03 medical and health sciences 0302 clinical medicine Capnography Internal medicine Tidal Volume medicine Animals Humans Lung volumes 030212 general & internal medicine Lung Aged Anesthesiology and Intensive Care business.industry Respiration Reproducibility of Results food and beverages Lung volume measurement 030208 emergency & critical care medicine General Medicine Lung protective ventilation Experimental validation Middle Aged respiratory system respiratory tract diseases Anesthesiology and Pain Medicine Models Animal Cardiology Female ventilator lung Lung Volume Measurements business
Zdroj:	Acta Anaesthesiologica Scandinavica. 64:670-676
ISSN:	1399-6576 0001-5172
DOI:	10.1111/aas.13552
Popis:	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.
Databáze:	OpenAIRE
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