Single-breath CO diffusing capacity influenced by initial alveolar partial pressure of CO

The purpose of this study was to assess the influence of incorrect determinations of the initial alveolar partial pressure of carbon monoxide (CO) at the beginning of breath holding (PIACO) on the pulmonary CO diffusing capacity of the lung (DLCO). Single-breath maneuvers were performed on 14 anesthetized and artificially ventilated rabbits, using 0.2% CO in nitrogen as the indicator gas mixture. Inflation and deflation procedures were carried out in an identical manner on each animal, with inflation always starting from residual volume. End-tidal partial pressure of CO was determined by respiratory mass spectrometry and was used to calculate DLCO values with the application of the three-equation (method 1), as well as the conventional (method 2), solution. In each rabbit, method 2 caused DLCO values to be overestimated when compared with method 1, and this overestimation decreased with increasing time intervals of CO uptake. Because we were able to recalculate this deviation using PIACO values that were obtained by taking the diffusive removal of CO during inflation into account, we concluded that errors in estimating PIACO by applying method 2 significantly contribute to the discrepancy between both methods.