Measurement of functional residual capacity by nitrogen washout during partial ventilatory support.

OBJECTIVE

Evaluation of an open circuit multiple breath nitrogen washout (MBNW) technique for measurement of functional residual capacity (FRC) during partial ventilatory support using corrections for gas viscosity, sampling delay time, and re-inspired nitrogen.

DESIGN

Measurements in a lung model with known reference volume simulating spontaneous breathing and duplicate measurements in patients breathing spontaneously with partial ventilatory support. SETTING. Experimental laboratory and intensive care units of a university hospital.

PATIENTS

Eighteen patients with acute respiratory failure.

INTERVENTIONS

Change of FiO(2) from baseline to 1.0.

MEASUREMENTS AND MAIN RESULTS

FRC was measured by MBNW during spontaneous breathing with continuous positive airway pressure, pressure support ventilation, proportional assist ventilation, automatic tube compensation, and airway pressure release ventilation. In the lung model, repeated measurements at three volumes were done with all partial ventilatory support modalities, and baseline FiO(2 )was varied with one mode and FRC. The mean of differences between MBNW (FRC(MBNW)) and reference was 28 ml (1.6%), and the 2.SD-interval was 84 ml (4.9%) for all modes. Measurements up to a baseline FiO(2) of 0.8 showed differences of 5 ml (-0.3%) and the 2.SD-interval of 38 ml (2.2%) between reference and FRC(MBNW). In 18 patients, 66 duplicate measurements revealed a mean difference of 30 ml (0.9%) with a coefficient of repeatability of 358 ml (13%) independent of ventilatory mode and chronological order.

CONCLUSION

This study suggests that, using corrections for gas viscosity, sampling delay time, and re-inspired nitrogen, FRC can be determined with good repeatability in patients and good accuracy in a lung model during partial ventilatory support.