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Capnography reflects ventilation/perfusion distribution in a model of acute lung injury
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
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2011 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 5, 597-606 p.Article in journal (Refereed) Published
Abstract [en]

Background: Changes in the shape of the capnogram may reflect changes in lung physiology. We studied the effect of different ventilation/perfusion ratios (V/Q) induced by positive end-expiratory pressures (PEEP) and lung recruitment on phase III slope (S(III) ) of volumetric capnograms. Methods: Seven lung-lavaged pigs received volume control ventilation at tidal volumes of 6 ml/kg. After a lung recruitment maneuver, open-lung PEEP (OL-PEEP) was defined at 2 cmH(2) O above the PEEP at the onset of lung collapse as identified by the maximum respiratory compliance during a decremental PEEP trial. Thereafter, six distinct PEEP levels either at OL-PEEP, 4 cmH(2) O above or below this level were applied in a random order, either with or without a prior lung recruitment maneuver. Ventilation-perfusion distribution (using multiple inert gas elimination technique), hemodynamics, blood gases and volumetric capnography data were recorded at the end of each condition (minute 40). Results: S (III) showed the lowest value whenever lung recruitment and OL-PEEP were jointly applied and was associated with the lowest dispersion of ventilation and perfusion (Disp(R-E) ), the lowest ratio of alveolar dead space to alveolar tidal volume (VD(alv) /VT(alv) ) and the lowest difference between arterial and end-tidal pCO(2) (Pa-ETCO(2) ). Spearman's rank correlations between S(III) and Disp(R-E) showed a ρ=0.85 with 95% CI for ρ (Fisher's Z-transformation) of 0.74-0.91, P<0.0001. Conclusion: In this experimental model of lung injury, changes in the phase III slope of the capnograms were directly correlated with the degree of ventilation/perfusion dispersion.

Place, publisher, year, edition, pages
2011. Vol. 55, no 5, 597-606 p.
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Medical and Health Sciences
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URN: urn:nbn:se:uu:diva-151480DOI: 10.1111/j.1399-6576.2011.02404.xISI: 000289365000015PubMedID: 21342153OAI: oai:DiVA.org:uu-151480DiVA: diva2:410083
Available from: 2011-04-12 Created: 2011-04-12 Last updated: 2017-12-11Bibliographically approved

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