title: Functional residual capacity measurement by heptafluoropropane in ventilated newborn lungs: in vitro and in vivo validation.
abstract: OBJECTIVE
  Heptafluoropropane is an inert gas commercially used as propellant for inhalers. Since heptafluoropropane can be detected in low concentrations, it could also be used as a tracer gas to measure functional residual capacity and ventilation homogeneity. The aim of the present study was to validate functional residual capacity measurements by heptafluoropropane wash-in/wash-out (0.8%) during mechanical ventilation in small, surfactant-depleted lungs using a newborn piglet model.
  
  
  METHODS
  Prospective laboratory and animal trial.
  
  
  METHODS
  Animal laboratory in a university setting.
  
  
  METHODS
  Sixteen newborn piglets (age<12 hrs, median weight 1390 g [705-4200 g]) before and after surfactant depletion (Pao2<100 torr in Fio2=1.0) by lung lavage.
  
  
  METHODS
  Heptafluoropropane was measured with a new infrared mainstream sensor connected with the flow sensor of the Dräger Babylog 8000. Accuracy and precision of the measurement technique were tested in a mechanical lung model with a volume range from 11 to 35 mL. Reproducibility of the method and its sensitivity to detect changes of functional residual capacity were assessed in vivo by variation of ventilatory variables.
  
  
  RESULTS
  In vitro the absolute error of functional residual capacity was <1 mL (relative errors<3%) with a coefficient of variation<4%. The coefficient of variation of consecutive in vivo measurements was only slightly higher (<5.1%). Measurement of heptafluoropropane concentrations in blood showed no significant accumulation for repeated functional residual capacity measurements within short time periods. After lung lavage, the functional residual capacity decreased from 20.9 mL/kg to 14.5 mL/kg (p<.05) despite increased ventilatory pressures, and lung clearance index (p<.001) and moment ratios (p<.01) increased significantly due to uneven alveolar ventilation. In healthy lungs, the increase in peak inflation pressure and positive end-expiratory pressure by 3-4 cm H2O had only a moderate effect on functional residual capacity (20.9+/-8.6 vs. 26.0+/-11.9 mL/kg, p=.17) and no effect on ventilatory homogeneity, whereas in surfactant-depleted lungs the functional residual capacity increased from 14.5+/-6.7 mL/kg to 29.9+/-12.6 mL/kg (p<.001) and lung clearance index and moment ratios decreased significantly (p < .01).
  
  
  CONCLUSIONS
  Heptafluoropropane is a suitable tracer gas for precise functional residual capacity measurements tested in vitro and allows for reproducible measurements in ventilated small lungs without any adverse effects on mechanical ventilation. The sensitivity of the method is sufficiently high to demonstrate the effect of changes in ventilatory settings on the functional residual capacity and ventilation homogeneity.
authors.affiliation: Clinic of Neonatology, Charité Campus Mitte, and Institute of Legal Medicine, Charité Universitätsmedizin, Berlin, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Proquitté
authors.forename: Ariane
authors.initials: A
authors.lastname: Kusztrich
authors.forename: Volker
authors.initials: V
authors.lastname: Auwärter
authors.forename: Fritz
authors.initials: F
authors.lastname: Pragst
authors.forename: Roland R
authors.initials: RR
authors.lastname: Wauer
authors.forename: Gerd
authors.initials: G
authors.lastname: Schmalisch
mesh_terms: D000280:Administration, Inhalation; D000335:Aerosol Propellants / Q000008:administration & dosage / Q000493:pharmacokinetics; D000818:Animals; D000831:Animals, Newborn; D005652:Functional Residual Capacity / Q000502:physiology*; D006845:Hydrocarbons, Fluorinated / Q000008:administration & dosage / Q000493:pharmacokinetics; D066298:In Vitro Techniques; D008168:Lung / Q000502:physiology*; D011446:Prospective Studies; D012121:Respiration, Artificial; D013552:Swine; D005466:Fluorocarbons
chemical_list: D000335:Aerosol Propellants; D006845:Hydrocarbons, Fluorinated; C094049:apaflurane; D005466:Fluorocarbons