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Related Experiment Videos

Ventilation inhomogeneity during controlled ventilation. Which index should be used?

A Larsson1, C Jonmarker, O Werner

  • 1Department of Anesthesia, University Hospital, Lund, Sweden.

Journal of Applied Physiology (Bethesda, Md. : 1985)
|November 1, 1988
PubMed
Summary

Six indexes for diagnosing uneven lung ventilation were assessed. Those unaffected by tidal volume or dead space, like mixing ratio, are best for evaluating pulmonary gas mixing in patients.

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Area of Science:

  • Pulmonary Physiology
  • Respiratory Medicine
  • Diagnostic Imaging

Background:

  • Pulmonary gas mixing is crucial for efficient respiration.
  • Assessing ventilation distribution is key in diagnosing lung diseases.
  • Tracer gas washout is a method to evaluate gas mixing.

Purpose of the Study:

  • To evaluate six indexes derived from tracer gas washout for diagnosing uneven pulmonary ventilation.
  • To compare the performance of these indexes under varying physiological conditions and patient types.

Main Methods:

  • Studied six indexes: lung clearance index, mixing ratio, Becklake index, multiple-breath alveolar mixing inefficiency, moment ratio, and pulmonary clearance delay.
  • Utilized model lung tests to assess index sensitivity to tidal volume and dead space.

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  • Analyzed index performance in spontaneously breathing and mechanically ventilated patients, comparing smokers and nonsmokers.

    • Main Results:

    • Indexes comparing actual to ideal washout curves (mixing ratio, multiple-breath alveolar mixing inefficiency, pulmonary clearance delay) were robust against tidal volume and dead space changes.
    • All indexes showed significant differences between smokers and nonsmokers (P < 0.002).
    • Different indexes varied in assessing various ventilatory patterns, with fast insufflation and end-inspiratory pause yielding lowest mean values for most.

    Conclusions:

    • Mixing ratio, multiple-breath alveolar mixing inefficiency, and pulmonary clearance delay are preferable for assessing pulmonary gas mixing due to their independence from tidal volume and dead space.
    • All studied indexes can be useful if their limitations are understood.
    • Tracer gas washout indexes effectively differentiate between smokers and nonsmokers regarding ventilation patterns.