title: The effect of alveolar dead space on the measurement of end-expiratory lung volume by modified nitrogen wash-out/wash-in in lavage-induced lung injury.
abstract: BACKGROUND
  The accuracy of end-expiratory lung volume measurement by the modified nitrogen wash-out/wash-in method (EELV-N(2)) depends on the precise determination of carbon dioxide elimination (V(CO(2))), which is affected by alveolar dead space (V(D-alv)). The purpose of this study was to investigate the influence of V(D-alv) on EELV-N(2).
  
  
  METHODS
  Six piglets with lavage-induced acute lung injury were mechanically ventilated in a decremental PEEP trial that was reduced from 20 to 4 cm H(2)O in steps of 4 cm H(2)O every 10 min. EELV was measured by the modified EELV-N(2) method and computed tomography scan (EELV-CT), volumetric capnography, blood gas measurements, and hemodynamic data were recorded at each PEEP level. The data were divided into higher and lower PEEP groups.
  
  
  RESULTS
  During the decremental PEEP trial, EELV-N(2) exhibited a high correlation (r(2) = 0.86, P < .001) with EELV-CT, with a bias of -48.6 ± 150.7 mL (1 ± 18%). In the higher PEEP group, EELV-N(2) was not correlated with EELV-CT, with a bias of -168.1 ± 171.5 mL (-14 ± 14%). However, in the lower PEEP group, EELV-N(2) exhibited a high correlation (r(2) = 0.86, P < .001) with EELV-CT, with a bias of 11.2 ± 97.2 mL (6 ± 17%). The measurement bias was negatively correlated with V(D-alv) (r(2) = 0.44, P = .04) and V(CO(2)) (r(2) = 0.47, P = .03) in the higher PEEP group.
  
  
  CONCLUSIONS
  In this surfactant-depleted model, EELV measurement by the modified EELV-N(2) method reveals a systematic underestimation at high PEEP levels that is partly due to an increase in V(D-alv).
authors.affiliation: Department of Critical Care Medicine, Southeast University School of Medicine, Nanjing, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Tang
authors.forename: Yingzi
authors.initials: Y
authors.lastname: Huang
authors.forename: Qiuhua
authors.initials: Q
authors.lastname: Chen
authors.forename: Xia
authors.initials: X
authors.lastname: Hui
authors.forename: Yang
authors.initials: Y
authors.lastname: Li
authors.forename: Qing
authors.initials: Q
authors.lastname: Yu
authors.forename: Hongjie
authors.initials: H
authors.lastname: Zhao
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.forename: Haibo
authors.initials: H
authors.lastname: Qiu
mesh_terms: D055371:Acute Lung Injury / Q000503:physiopathology*; D000818:Animals; D019296:Capnography; D004195:Disease Models, Animal; D005260:Female; D008176:Lung Volume Measurements; D008297:Male; D009584:Nitrogen; D011175:Positive-Pressure Respiration; D011650:Pulmonary Alveoli; D012126:Respiratory Dead Space / Q000502:physiology*; D013552:Swine; D007507:Therapeutic Irrigation
chemical_list: D009584:Nitrogen