Modelling mixing within the dead space of the lung improves predictions of functional residual capacity.
Routine estimation of functional residual capacity (FRC) in ventilated patients has been a long held goal, with many methods previously proposed, but none have been used in routine clinical practice. This paper proposes three models for determining FRC using the nitrous oxide concentration from the entire expired breath in order to improve the precision of the estimate. Of the three models proposed, a dead space with two mixing compartments provided the best results, reducing the mean limits of agreement with the FRC measured by whole body plethysmography by up to 41%. This moves away from traditional lung models, which do not account for mixing within the dead space. Compared to literature values for FRC, the results are similar to those obtained using helium dilution and better than the LUFU device (Dräger Medical, Lubeck, Germany), with significantly better limits of agreement compared to plethysmography.
Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, OX3 7DQ, UK. Electronic address: christopher.harrison@strath.ac.uk.
Chris D
CD
Harrison
Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
Phi Anh
PA
Phan
New College, University of Oxford, Holywell Street, Oxford, OX1 3BN, UK.
Cathy
C
Zhang
The Queen's College, University of Oxford, High Street, Oxford, OX1 4AW, UK.
Daniel
D
Geer
Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
Andrew D
AD
Farmery
Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, OX3 7DQ, UK. Electronic address: stephen.payne@eng.ox.ac.uk.
Stephen J
SJ
Payne
D001944:Breath Tests / Q000295:instrumentation / Q000379:methods; D003198:Computer Simulation; D005260:Female; D005652:Functional Residual Capacity / Q000502:physiology; D006371:Helium; D006801:Humans; D016018:Least-Squares Analysis; D008168:Lung / Q000033:anatomy & histology / Q000502:physiology*; D008297:Male; D008954:Models, Biological; D009609:Nitrous Oxide / Q000032:analysis; D010993:Plethysmography, Whole Body; D012044:Regression Analysis; D012119:Respiration; D012126:Respiratory Dead Space; D055815:Young Adult
D006371:Helium; D009609:Nitrous Oxide
Airway dead space; Alveolar volume; Functional residual capacity; Lung function; Mathematical model; Mechanical ventilation; Nitrous oxide; Parameter estimation