Determination of lung volume by single- and multiple-breath nitrogen washout

In 10 normal volunteers, total lung capacity determined from a single-breath N2 washout was not significantly different from that determined by body plethysmography. However, in patients who underwent clinical pulmonary function tests, total lung capacity was substantially underestimated by the single-breath N2 washout, compared with that determined by either body plethysmography or the 7-min open-circuit N2 washout method. The single-breath N2 washout underestimated total lung capcity in patients who had a normal slope of Phase III, and the error was even greater in patients who had steeper Phase III slopes or low maximal mid-expiratory flow values. Total lung capacity determined by 5 vital capacity breath N2 washout method was comparable to that determined by the 7-min N2 washout method, provided that expired N2 did not exceed 10 per cent during the fifth vital capcity maneuver. By extending the washout beyond 5 vital capacity maneuvers when necessary to achieve a peak expired N2 of less than 10 per cent, a mean total lung capacity within 1 per cent of that determined by the 7-min washout method was obtained. The multiple vital capacity maneuver was well tolerated by patients and saved considerable time.