title: Four methods of measuring tidal volume during high-frequency oscillatory ventilation.
abstract: OBJECTIVE
  Assess the accuracy of four different methods of measuring tidal volume during simulated high-frequency oscillatory ventilation.
  
  
  METHODS
  In vitro study.
  
  
  METHODS
  Research laboratory.
  
  
  METHODS
  Three differential pressure pneumotachometers, a modified Pitot tube, an ultrasound flowmeter, and an adult hot wire anemometer.
  
  
  METHODS
  Each device was placed in series with a Sensormedics 3100B high-frequency ventilator and an 8.0-mm endotracheal tube attached to a 48.9-L plethysmograph. Inspiratory/expiratory ratio was fixed at 1:1 and mean airway pressure at 10 cm H2O. Tidal volumes were calculated at each combination of frequency (f: 3, 4, 6, 8, 10, 12 Hz) and pressure amplitude (DeltaP: 30, 60, 90 cm H2O) by digital integration of the sampled flow signals from each device and compared with those calculated from pressure changes within the plethysmograph. The protocol was repeated after incorporation of frequency-specific calibrations to the flow-measuring algorithm of each device. The hot wire anemometer was further evaluated at Fio2 of 1.0, 37 degrees C, 80% humidity, mean airway pressure of 20 cm H2O, and an inspiratory/expiratory ratio of 1:2.
  
  
  RESULTS
  Tidal volumes were 36-305 mL. Bland-Altman analysis demonstrated that each device exhibited systematic bias before frequency-specific adjustment. After frequency-specific adjustment of the flow-measuring algorithm, the two most accurate and precise devices were the Hans Rudolph pneumotachometer, which exhibited a mean error of 0.2% (95% confidence interval, -3.0% to 3.4%), and the hot wire anemometer, which had a mean error of -1.1% (95% confidence interval, -5.5% to 3.3%). The hot wire anemometer remained accurate at Fio2 1.0, 37 degrees C, 80% humidity, mean airway pressure of 20 cm H2O, and an inspiratory/expiratory ratio of 1:2.
  
  
  CONCLUSIONS
  Tidal volume can be measured during high-frequency oscillatory ventilation using a variety of techniques. Frequency-specific calibration improves the accuracy and precision of tidal volume measurements. Hot wire anemometry exhibits stable performance characteristics across the range of temperature, humidity, Fio2, and inspiratory/expiratory ratios encountered clinically, has a small deadspace, is unaffected by mean airway pressure, and is therefore suitable for clinical applications.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: David N
authors.initials: DN
authors.lastname: Hager
authors.forename: Mathew
authors.initials: M
authors.lastname: Fuld
authors.forename: David W
authors.initials: DW
authors.lastname: Kaczka
authors.forename: Henry E
authors.initials: HE
authors.lastname: Fessler
authors.forename: Roy G
authors.initials: RG
authors.lastname: Brower
authors.forename: Brett A
authors.initials: BA
authors.lastname: Simon
mesh_terms: D000328:Adult; D006612:High-Frequency Ventilation / Q000379:methods*; D006801:Humans; D066298:In Vitro Techniques; D016014:Linear Models; D010991:Plethysmography / Q000295:instrumentation* / Q000379:methods; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation*; D013990:Tidal Volume