CO(2)-controlled sampling of alveolar gas in mechanically ventilated patients

A newly designed gas-sampling device using end-tidal CO(2) to separate dead space gas from alveolar gas was evaluated in 12 mechanically ventilated patients. For that purpose, CO(2)-controlled sampling was compared with mixed expiratory sampling. Alveolar sampling valves were easily controlled via CO(2) concentration. Concentrations of four volatile substances were determined in the expired and inspired gas. Isoflurane and isoprene, which did not occur in the inspired air, had ratios of end-tidal to mixed expired concentrations of 1.75 and 1.81, respectively. Acetone and pentane, found in both the inspired and expired air, showed ratios of 0.96 and 1.0, respectively. Precision of concentration measurements was between 2.4% (isoprene) and 11.2% (isoflurane); reproducibility (as coefficient of variation) was 5%. Because the only possible source of isoflurane and isoprene in this setting was patients' blood, selective enrichment of alveolar gas was demonstrated. By using the new sampling technique, sensitivity of breath analysis was nearly doubled.