ABSTRACT
End tidal carbon dioxide tension (P(ET,CO(2))) is a surrogate for dead space ventilation which may be useful in the evaluation of pulmonary embolism (PE). We aimed to define the optimal P(ET,CO(2)) level to exclude PE in patients evaluated for possible thromboembolism. 298 patients were enrolled over 6 months at a single academic centre. P(ET,CO(2)) was measured within 24 h of contrast-enhanced helical computed tomography, lower extremity duplex or ventilation/perfusion scan. Performance characteristics were measured by comparing test results with clinical diagnosis of PE. PE was diagnosed in 39 (13%) patients. Mean P( ET,CO(2)) in healthy volunteers did not differ from P( ET,CO(2)) in patients without PE (36.3+/-2.8 versus 35.5+/-6.8 mmHg). P(ET,CO(2 )) in patients with PE was 30.5+/-5.5 mmHg (p<0.001 versus patients without PE). A P(ET,CO(2)) of >or=36 mmHg had optimal sensitivity and specificity (87.2 and 53.0%, respectively) with a negative predictive value of 96.6% (95% CI 92.3-98.5). This increased to 97.6% (95% CI 93.2-99.) when combined with Wells score <4. A P(ET,CO(2)) of >or=36 mmHg may reliably exclude PE. Accuracy is augmented by combination with Wells score. P( ET,CO(2)) should be prospectively compared to D-dimer in accuracy and simplicity to exclude PE.
Subject(s)
Breath Tests/instrumentation , Carbon Dioxide/metabolism , Point-of-Care Systems/standards , Pulmonary Embolism/diagnosis , Pulmonary Embolism/metabolism , Adult , Aged , Female , Humans , Male , Mass Screening/instrumentation , Mass Screening/standards , Middle Aged , Pilot Projects , Predictive Value of Tests , Prospective Studies , ROC Curve , Reproducibility of Results , Respiratory Dead Space , Sensitivity and SpecificityABSTRACT
We investigate a parametrically excited nonlinear Mathieu equation with damping and limited spatial dependence, using both perturbation theory and numerical integration. The perturbation results predict that, for parameters which lie near the 2:1 resonance tongue of instability corresponding to a single mode of shape cos nx, the resonant mode achieves a stable periodic motion, while all the other modes are predicted to decay to zero. By numerically integrating the p.d.e. as well as a 3-mode o.d.e. truncation, the predictions of perturbation theory are shown to represent an oversimplified picture of the dynamics. In particular it is shown that steady states exist which involve many modes. The dependence of steady state behavior on parameter values and initial conditions is investigated numerically. (c) 1999 American Institute of Physics.