Validation of measurements of ventilation-to-perfusion ratio inequality in the lung from expired gas

2003 ◽  
Vol 94 (3) ◽  
pp. 1186-1192 ◽  
Author(s):  
G. Kim Prisk ◽  
Harold J. B. Guy ◽  
John B. West ◽  
James W. Reed
Keyword(s):  
Gas Exchange ◽  
Respiratory Exchange Ratio ◽  
Blood Gases ◽  
Inert Gas ◽  
Phase Iii ◽  
Strongly Correlated ◽  
Arterial Blood Gases ◽  
Arterial Blood ◽  
Expired Gas ◽  
The Relationship

The analysis of the gas in a single expirate has long been used to estimate the degree of ventilation-perfusion (V˙a/Q˙) inequality in the lung. To further validate this estimate, we examined three measures ofV˙a/Q˙ inhomogeneity calculated from a single full exhalation in nine anesthetized mongrel dogs under control conditions and after exposure to aerosolized methacholine. These measurements were then compared with arterial blood gases and with measurements of V˙a/Q˙ inhomogeneity obtained using the multiple inert gas elimination technique. The slope of the instantaneous respiratory exchange ratio (R slope) vs. expired volume was poorly correlated with independent measures, probably because of the curvilinear nature of the relationship due to continuing gas exchange. When R was converted to the intrabreathV˙a/Q˙ (iV˙/Q˙), the best index was the slope of iV˙/Q˙ vs. volume over phase III (iV˙/Q˙slope). This was strongly correlated with independent measures, especially those relating to inhomogeneity of perfusion. The correlations for iV˙/Q˙ slope and R slope considerably improved when only the first half of phase III was considered. We conclude that a useful noninvasive measurement ofV˙a/Q˙ inhomogeneity can be derived from the intrabreath respiratory exchange ratio.

Arterial blood gases in man during inert gas narcosis.

1974 ◽  
Vol 36 (1) ◽  
pp. 45-48 ◽  
Author(s):  
P B Bennett ◽  
G D Blenkarn
Keyword(s):  
Blood Gases ◽  
Inert Gas ◽  
Arterial Blood Gases ◽  
Arterial Blood

Arterial Blood Gases, Acid-Base Balance, and Lactate and Gas Exchange Variables During Hypoxic Exercise

1989 ◽  
Vol 10 (04) ◽  
pp. 279-285 ◽  
Author(s):  
T. Yoshida ◽  
M. Udo ◽  
M. Chida ◽  
K. Makiguchi ◽  
M. Ichioka ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Blood Gases ◽  
Arterial Blood Gases ◽  
Acid Base Balance ◽  
Acid Base ◽  
Arterial Blood ◽  
Base Balance ◽  
Hypoxic Exercise

scholarly journals Tidal Volume, Lung Hyperinflation and Arterial Oxygenation during General Anaesthesia

1993 ◽  
Vol 21 (6) ◽  
pp. 806-810 ◽  
Author(s):  
W. A. Tweed ◽  
W. T. Phua ◽  
K. Y. Chong ◽  
E. Lim ◽  
T. L. Lee
Keyword(s):  
Gas Exchange ◽  
Tidal Volume ◽  
General Anaesthesia ◽  
Blood Gases ◽  
Arterial Oxygenation ◽  
Arterial Blood Gases ◽  
Controlled Ventilation ◽  
Arterial Blood ◽  
Patients At Risk ◽  
Induction Of Anaesthesia

Impaired pulmonary oxygen (O2) exchange is common during general anaesthesia but there is no clinical unanimity as to methods of prevention or treatment. We studied 14 patients at risk for pulmonary dysfunction because of increased age, obesity, cigarette smoking, or chronic lung disease. Pulmonary O2 exchange was measured during four conditions of ventilation: awake spontaneous, conventional tidal volume (CVT, 7 ml.kg-1) or high tidal volume (HVT, 12 ml.kg-1) controlled ventilation, and five min after manual hyperinflation (H1) of the lungs. The F1O2 was controlled at 0.5, and FETCO2 was kept constant by adding dead space during HVT. Eight patients were ventilated with N2O/O2 and six with air/O2. Arterial blood gases were used to calculate the (A-a)DO2. In seven patients (A-a)DO2 worsened after induction of anaesthesia, while in seven there was no change or an improvement. Manual HI significantly reduced (A-a)DO2, but changing tidal volume (VT) had no effect. Using a multivariate model to predict O2 exchange, obesity and type of surgery were significantly associated with worsening, while level of VT and inspiratory gas (N2O or N2) were not significant predictors. Thus patient and surgical factors were more important determinants of pulmonary gas exchange during anaesthesia than were tidal volume or inspiratory gas. Manual HI is a simple and effective manoeuvre to improve gas exchange.

scholarly journals Do We Need Exercise Tests to Detect Gas Exchange Impairment in Fibrotic Idiopathic Interstitial Pneumonias?

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Benoit Wallaert ◽  
Lidwine Wemeau-Stervinou ◽  
Julia Salleron ◽  
Isabelle Tillie-Leblond ◽  
Thierry Perez
Keyword(s):  
Gas Exchange ◽  
Cardiopulmonary Exercise Testing ◽  
Blood Gases ◽  
Oxygen Desaturation ◽  
Walk Test ◽  
Diffusing Capacity ◽  
Arterial Blood Gases ◽  
Exercise Tests ◽  
Cardiopulmonary Exercise ◽  
Arterial Blood

In patients with fibrotic idiopathic interstitial pneumonia (f-IIP), the diffusing capacity for carbon monoxide (DLCO) has been used to predict abnormal gas exchange in the lung. However, abnormal values for arterial blood gases during exercise are likely to be the most sensitive manifestations of lung disease. The aim of this study was to compare DLCO, resting PaO2, P(A-a)O2at cardiopulmonary exercise testing peak, and oxygen desaturation during a 6-min walk test (6MWT). Results were obtained in 121 patients with idiopathic pulmonary fibrosis (IPF,n=88) and fibrotic nonspecific interstitial pneumonias (NSIP,n=33). All but 3 patients (97.5%) had low DLCO values (<LLN) whereas only 66.6% had low KCO; 42 patients (65%) exhibited resting hypoxemia (<75 mmHg); 112 patients (92.5%) exhibited a high P[(A-a)O2], peak (>35 mmHg) and 100 (83%) demonstrated significant oxygen desaturation during 6MWT (>4%). Interestingly 27 patients had low DLCO and normal P(A-a)O2, peak and/or no desaturation during the 6MWT. The 3 patients with normal DLCO also had normal PaO2, normal P(A-a)O2, peak, and normal oxygen saturation during 6MWT. Our results demonstrate that in fibrotic IIP, DLCO better defines impairment of pulmonary gas exchange than resting PaO2, exercise P(A-a)O2, peak, or 6MWT SpO2.

Ventilation-perfusion relationships during induced normovolemic polycythemia in dogs

1988 ◽  
Vol 65 (4) ◽  
pp. 1686-1692 ◽  
Author(s):  
A. A. Balgos ◽  
D. C. Willford ◽  
J. B. West
Keyword(s):  
Gas Exchange ◽  
Blood Gases ◽  
Normal Subjects ◽  
Pulmonary Gas Exchange ◽  
Inert Gas ◽  
Base Line ◽  
Slight Improvement ◽  
Arterial Blood ◽  
The Mean ◽  
Arterial Po2

Previous studies on normal subjects and patients with polycythemia have given conflicting results of the effect of polycythemia on pulmonary gas exchange. We studied acutely induced normovolemic polycythemia in the dog and measured arterial blood gases and ventilation-perfusion (VA/Q) relationships using the multiple inert gas elimination technique. The mean base-line hematocrit of 43 +/- 5% was increased to 57 +/- 4 and 68 +/- 8%, respectively, after two exchange transfusions of packed erythrocytes. Subsequent plasma exchange transfusions returned the mean hematocrit to 44 +/- 4%. Polycythemia caused no significant arterial hypoxemia; indeed there was a slight improvement in the alveolar-arterial PO2 difference. The multiple inert gas elimination measurements showed no increase in VA/Q inhomogeneity with no increase in log SD ventilation (V) or log SD blood flow (Q). There was a shift of mean V and mean Q to high VA/Q areas because of a decrease in cardiac output, presumably caused by increased blood viscosity. This study showed no deleterious effects on pulmonary gas exchange within the hematocrit range of 36-76%.

Linear programming analysis of VA/Q distributions: limits on central moments

1986 ◽  
Vol 60 (5) ◽  
pp. 1772-1781 ◽  
Author(s):  
K. S. Kapitan ◽  
P. D. Wagner
Keyword(s):  
Linear Programming ◽  
Confidence Intervals ◽  
Infinite Family ◽  
Blood Gases ◽  
Basic Structure ◽  
Inert Gas ◽  
Retention Data ◽  
Arterial Blood Gases ◽  
Central Moments ◽  
Arterial Blood

Linear programming examines the boundaries of infinite sets. We used this method with the multiple-inert gas-elimination technique to examine the central moments and arterial blood gases of the infinite family of ventilation perfusion (VA/Q) distributions that are compatible with a measured inert gas-retention set. A linear program was applied with Monte-Carlo error simulation to theoretical retention data, and 95% confidence intervals were constructed for the first three moments (mean, dispersion, and skew) and the arterial PO2 and PCO2 of all compatible blood flow distributions. Six typical cases were studied. Results demonstrate narrow confidence intervals for both the lower moments and predicted arterial blood gases of all test cases, which widen as moment number or error increase. We conclude that the blood gas composition and basic structure of all compatible VA/Q distributions are tightly constrained and that even subtle changes in this structure, as may occur experimentally, can be identified.

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