title: Effects of reduced rebreathing time, in spontaneously breathing patients, on respiratory effort and accuracy in cardiac output measurement when using a partial carbon dioxide rebreathing technique: a prospective observational study.
abstract: BACKGROUND
  New technology using partial carbon dioxide rebreathing has been developed to measure cardiac output. Because rebreathing increases respiratory effort, we investigated whether a newly developed system with 35 s rebreathing causes a lesser increase in respiratory effort under partial ventilatory support than does the conventional system with 50 s rebreathing. We also investigated whether the shorter rebreathing period affects the accuracy of cardiac output measurement.
  
  
  METHODS
  Once a total of 13 consecutive post-cardiac-surgery patients had recovered spontaneous breathing under pressure support ventilation, we applied a partial carbon dioxide rebreathing technique with rebreathing of 35 s and 50 s in a random order. We measured minute ventilation, and arterial and mixed venous carbon dioxide tension at the end of the normal breathing period and at the end of the rebreathing periods. We then measured cardiac output using the partial carbon dioxide rebreathing technique with the two rebreathing periods and using thermodilution.
  
  
  RESULTS
  With both rebreathing systems, minute ventilation increased during rebreathing, as did arterial and mixed venous carbon dioxide tensions. The increases in minute ventilation and arterial carbon dioxide tension were less with 35 s rebreathing than with 50 s rebreathing. The cardiac output measures with both systems correlated acceptably with values obtained with thermodilution.
  
  
  CONCLUSIONS
  When patients breathe spontaneously the partial carbon dioxide rebreathing technique increases minute ventilation and arterial carbon dioxide tension, but the effect is less with a shorter rebreathing period. The 35 s rebreathing period yielded cardiac output measurements similar in accuracy to those with 50 s rebreathing.
authors.affiliation: Surgical Intensive Care Unit, National Cardiovascular Center, Osaka, Japan. ktachiba@hsp.ncvc.go.jp
authors.forename: Kazuya
authors.initials: K
authors.lastname: Tachibana
authors.forename: Hideaki
authors.initials: H
authors.lastname: Imanaka
authors.forename: Muneyuki
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Tomoyo
authors.initials: T
authors.lastname: Nishida
authors.forename: Yuji
authors.initials: Y
authors.lastname: Takauchi
authors.forename: Masaji
authors.initials: M
authors.lastname: Nishimura
mesh_terms: D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000008:administration & dosage*; D002248:Carbon Monoxide / Q000097:blood*; D002302:Cardiac Output / Q000502:physiology*; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012119:Respiration; D012121:Respiration, Artificial / Q000379:methods*; D015656:Respiratory Mechanics / Q000502:physiology; D018709:Statistics, Nonparametric; D013815:Thermodilution; D013997:Time Factors
chemical_list: D002245:Carbon Dioxide; D002248:Carbon Monoxide