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Corrections of Enghoffs dead space formula for shunt effects still overestimate Bohr's dead space
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
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2013 (English)In: Respiratory Physiology & Neurobiology, ISSN 1569-9048, E-ISSN 1878-1519, Vol. 189, no 1, 99-105 p.Article in journal (Refereed) Published
Abstract [en]

Dead space ratio is determined using Enghoffs modification (VDB-E/V-T) of Bohr's formula (V-DBohr/V-T) in which arterial is used as a surrogate of alveolar PCO2. In presence of intrapulmonary shunt Enghoffs approach overestimates dead space. In 40 lung-lavaged pigs we evaluated the Kuwabara's and Niklason's algorithms to correct for shunt effects and hypothesized that corrected VDB-E/V-T should provide similar values as V-DBohr/V-T. We analyzed 396 volumetric capnograms and arterial and mixed-venous blood samples to calculate V-DBohr/V-T and VDB-E/V-T. Thereafter, we corrected the latter for shunt effects using Kuwabara's (K) VDB-E/V-T and Niklason's (N) VDB-E/V-T algorithms. Uncorrected VDB-E/V-T (mean +/- SD of 0.70 +/- 0.10) overestimated V-DBohr/V-T (0.59 +/- 0.12) (p < 0.05), over the entire range of shunts. Mean (K) VDB-E/V-T was significantly higher than V-DBor/V-T (0.67 +/- 0.08, bias 0.085, limits of agreement 0.232 to 0.085; p< 0.05) whereas (N)VDB-E/V-T showed a better correction for shunt effects (0.64 +/- 0.09, bias 0.048, limits of agreement -0.168 to 0.072; p < 0.05). Neither Kuwabara's nor Niklason's algorithms were able to correct EnghofFs dead space formula for shunt effects. 

Place, publisher, year, edition, pages
2013. Vol. 189, no 1, 99-105 p.
Keyword [en]
Dead space, Shunt, PEEP, Acute lung injury, Bohr's formula, V-D/V-T
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-211465DOI: 10.1016/j.resp.2013.06.020ISI: 000326059100014OAI: oai:DiVA.org:uu-211465DiVA: diva2:667150
Available from: 2013-11-25 Created: 2013-11-25 Last updated: 2017-12-06Bibliographically approved

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Suarez-Sipmann, FernandoSantos, ArnoldoBorges, Joao BatistaHedenstierna, Göran

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Suarez-Sipmann, FernandoSantos, ArnoldoBorges, Joao BatistaHedenstierna, Göran
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