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A novel technique to determine dead space ventilation in ARDS

Joeke Nollet, Jonne Doorduin, Manon Vugts, Lisanne Roesthuis, Johannes van der Hoeven, Leo Heunks
European Respiratory Journal 2014 44: P2135; DOI:
Joeke Nollet
1Department of Critical Care Medicine, Radboud University Medical center, Nijmegen, Netherlands
2Department of Technical Medicine, MIRA – Institute for BioMedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands
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Jonne Doorduin
1Department of Critical Care Medicine, Radboud University Medical center, Nijmegen, Netherlands
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Manon Vugts
1Department of Critical Care Medicine, Radboud University Medical center, Nijmegen, Netherlands
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Lisanne Roesthuis
1Department of Critical Care Medicine, Radboud University Medical center, Nijmegen, Netherlands
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Johannes van der Hoeven
1Department of Critical Care Medicine, Radboud University Medical center, Nijmegen, Netherlands
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Leo Heunks
1Department of Critical Care Medicine, Radboud University Medical center, Nijmegen, Netherlands
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Abstract

Introduction: Bohr's dead space is the portion of tidal volume (VT) not participating in gas exchange with pulmonary blood flow. This parameter is important in patients with acute respiratory distress syndrome (ARDS) for treatment follow-up, ventilator settings optimization and prognostication. However, dead space calculation is cumbersome using current techniques. Recently, a novel technique based on volumetric capnography (VC) was validated. Our aim was to compare VC with current techniques in ARDS patients and controls.

Methods: In 15 ARDS patients and 15 controls (post-operative cardiac surgery) dead space (VD) was calculated with VC using the Bohr equation: VD/VT = (PACO2-PeCO2)/PACO2, where PACO2 and PeCO2 are alveolar and mixed expired CO2 tension. Both variables were calculated from a mathematical fit of the volumetric capnogram. Dead space was also calculated using the Bohr-Enghoff modification (arterial CO2 tension (PaCO2) instead of PACO2). PeCO2 was measured in expired air using a Douglas bag (DB) and via indirect calorimetry with a metabolic monitor (MM).

Results: In ARDS patients, dead space determined with VC (53±8%) was lower compared to DB (68±8%, p<0.0001) and MM (72±8%, p<0.0001). PeCO2 determined with MM (3.2±0.4 kPa) was higher compared to DB (2.5±0.3 kPa, p<0.05) and VC (2.5±0.3 kPa, p<0.05) in the controls. In ARDS patients, PeCO2 was higher with DB (2.1±0.4 kPa) compared to VC (1.8±0.4 kPa, p<0.05). PaCO2 was higher than PACO2 in the controls (5.2±0.5 vs. 4.3±0.5 kPa, p<0.0001) and ARDS patients (6.9±1.7 vs. 3.9±0.8 kPa, p<0.0001).

Conclusion: Current techniques, using PaCO2 instead of PACO2, overestimate dead space through pulmonary shunting. Volumetric capnography measures true Bohr's dead space.

  • ARDS (Acute Respiratory Distress Syndrome)
  • Gas exchange
  • Intensive care
  • © 2014 ERS
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A novel technique to determine dead space ventilation in ARDS
Joeke Nollet, Jonne Doorduin, Manon Vugts, Lisanne Roesthuis, Johannes van der Hoeven, Leo Heunks
European Respiratory Journal Sep 2014, 44 (Suppl 58) P2135;

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A novel technique to determine dead space ventilation in ARDS
Joeke Nollet, Jonne Doorduin, Manon Vugts, Lisanne Roesthuis, Johannes van der Hoeven, Leo Heunks
European Respiratory Journal Sep 2014, 44 (Suppl 58) P2135;
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