title: Variations in respiratory excretion of carbon dioxide can be used to calculate pulmonary blood flow.
abstract: BACKGROUND
  A non-invasive means of measuring pulmonary blood flow (PBF) would have numerous benefits in medicine. Traditionally, respiratory-based methods require breathing maneuvers, partial rebreathing, or foreign gas mixing because exhaled CO2 volume on a per-breath basis does not accurately represent alveolar exchange of CO2. We hypothesized that if the dilutional effect of the functional residual capacity was accounted for, the relationship between the calculated volume of CO2 removed per breath and the alveolar partial pressure of CO2 would be reversely linear.
  
  
  METHODS
  A computer model was developed that uses variable tidal breathing to calculate CO2 removal per breath at the level of the alveoli. We iterated estimates for functional residual capacity to create the best linear fit of alveolar CO2 pressure and CO2 elimination for 10 minutes of breathing and incorporated the volume of CO2 elimination into the Fick equation to calculate PBF.
  
  
  RESULTS
  The relationship between alveolar pressure of CO2 and CO2 elimination produced an R(2) = 0.83. The optimal functional residual capacity differed from the "actual" capacity by 0.25 L (8.3%). The repeatability coefficient leveled at 0.09 at 10 breaths and the difference between the PBF calculated by the model and the preset blood flow was 0.62 ± 0.53 L/minute.
  
  
  CONCLUSIONS
  With variations in tidal breathing, a linear relationship exists between alveolar CO2 pressure and CO2 elimination. Existing technology may be used to calculate CO2 elimination during quiet breathing and might therefore be used to accurately calculate PBF in humans with healthy lungs.
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Preiss
authors.affiliation: Department of Pathophysiology and Anesthesia, Nagoya City University School of Nursing, Nagoya City, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Azami
authors.affiliation: Department of Anesthesia, Perioperative and Pain Medicine, Harvard Medical School/Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Urman
keywords: Carbon dioxide elimination; Cardiac output; End-tidal carbon dioxide; Pulmonary blood flow