Tidal changes in PaO2 and their relationship to cyclical lung recruitment/derecruitment in a porcine lung injury model.

BACKGROUND: Tidal recruitment/derecruitment (R/D) of collapsed regions in lung injury has been presumed to cause respiratory oscillations in the partial pressure of arterial oxygen (PaO2). These phenomena have not yet been studied simultaneously. We examined the relationship between R/D and PaO2 oscillations by contemporaneous measurement of lung-density changes and PaO2. METHODS: Five anaesthetised pigs were studied after surfactant depletion via a saline-lavage model of R/D. The animals were ventilated with a mean fraction of inspired O2 (FiO2) of 0.7 and a tidal volume of 10 ml kg-1. Protocolised changes in pressure- and volume-controlled modes, inspiratory:expiratory ratio (I:E), and three types of breath-hold manoeuvres were undertaken. Lung collapse and PaO2 were recorded using dynamic computed tomography (dCT) and a rapid PaO2 sensor. RESULTS: During tidal ventilation, the expiratory lung collapse increased when I:E <1 [mean (standard deviation) lung collapse=15.7 (8.7)%; P<0.05], but the amplitude of respiratory PaO2 oscillations [2.2 (0.8) kPa] did not change during the respiratory cycle. The expected relationship between respiratory PaO2 oscillation amplitude and R/D was therefore not clear. Lung collapse increased during breath-hold manoeuvres at end-expiration and end-inspiration (14% vs 0.9-2.1%; P<0.0001). The mean change in PaO2 from beginning to end of breath-hold manoeuvres was significantly different with each type of breath-hold manoeuvre (P<0.0001). CONCLUSIONS: This study in a porcine model of collapse-prone lungs did not demonstrate the expected association between PaO2 oscillation amplitude and the degree of recruitment/derecruitment. The results suggest that changes in pulmonary ventilation are not the sole determinant of changes in PaO2 during mechanical ventilation in lung injury.

Intra-breath arterial oxygen oscillations detected by a fast oxygen sensor in an animal model of acute respiratory distress syndrome.

BACKGROUND: There is considerable interest in oxygen partial pressure (Po2) monitoring in physiology, and in tracking Po2 changes dynamically when it varies rapidly. For example, arterial Po2 ([Formula: see text]) can vary within the respiratory cycle in cyclical atelectasis (CA), where [Formula: see text] is thought to increase and decrease during inspiration and expiration, respectively. A sensor that detects these [Formula: see text] oscillations could become a useful diagnostic tool of CA during acute respiratory distress syndrome (ARDS). METHODS: We developed a fibreoptic Po2 sensor (<200 µm diameter), suitable for human use, that has a fast response time, and can measure Po2 continuously in blood. By altering the inspired fraction of oxygen ([Formula: see text]) from 21 to 100% in four healthy animal models, we determined the linearity of the sensor's signal over a wide range of [Formula: see text] values in vivo. We also hypothesized that the sensor could measure rapid intra-breath [Formula: see text] oscillations in a large animal model of ARDS. RESULTS: In the healthy animal models, [Formula: see text] responses to changes in [Formula: see text] were in agreement with conventional intermittent blood-gas analysis (n=39) for a wide range of [Formula: see text] values, from 10 to 73 kPa. In the animal lavage model of CA, the sensor detected [Formula: see text] oscillations, also at clinically relevant [Formula: see text] levels close to 9 kPa. CONCLUSIONS: We conclude that these fibreoptic [Formula: see text] sensors have the potential to become a diagnostic tool for CA in ARDS.

A modification of the Bohr method to determine airways deadspace for non-uniform inspired gas tensions.

BACKGROUND: The Bohr method is a technique to determine airways deadspace using a tracer gas such as carbon dioxide or nitrogen. It is based on the assumption that the inspired concentration of the tracer gas is constant throughout inspiration. However, in some lung function measurement techniques where inspired concentration of the tracer gas may be required to vary, or where rapid injection of the tracer gas is made in real time, uniform inspired concentration is difficult or impossible to achieve, which leads to inaccurate estimation of deadspace using the Bohr equation. One such lung function measurement technique is the inspired sinewave technique. OBJECTIVE: In this paper, we proposed a modification of the Bohr method, relaxing the requirement of absolute uniformity of tracer concentration in the inspired breath. METHOD: The new method used integration of flow and concentration. A computer algorithm sought an appropriate value of deadspace to satisfy the mass balance equation for each breath. A modern gas mixing apparatus with rapid mass flow controllers was used to verify the procedure. RESULT: Experiments on a tidally ventilated bench lung showed that the new method estimated dead space within 10% of the actual values whereas the traditional Bohr deadspace gave more than 50% error. CONCLUSION: The new method improved the accuracy of deadspace estimation when the inspired concentration is not uniform. This improvement would lead to more accurate diagnosis and more accurate estimations of other lung parameters such as functional residual capacity and pulmonary blood flow.

The effect of diffusion in the respiratory tree on the alveolar amplitude response technique (AART).

Theoretical data for the alveolar amplitude response technique (AART) (J. Appl. Physiol. 41 (1976) 419-424) for assessing lung function was simulated using a single path lung model. This model takes account of stratified inhomogeneities in gas concentrations within the respiratory tree. The data was inserted into previously published parameter recovery techniques that may be used to estimate dead-space volume, alveolar volume and cardiac output. These parameter recovery techniques are based on much simpler mathematical models that do not allow stratified inhomogeneities in gas concentrations. It was found that: (i) recovered dead-space volume depended significantly on the ventilation pattern and on the distribution of volume within of the conducting airways; (ii) alveolar volume was recovered to a good degree of accuracy; and (iii) the recovered value of cardiac output was highly dependent on both the choice of inert gas and parameter recovery technique.

A tidal ventilation model for oxygenation in respiratory failure.

We develop tidal-ventilation pulmonary gas-exchange equations that allow pulmonary shunt to have different values during expiration and inspiration, in accordance with lung collapse and recruitment during lung dysfunction (Am. J. Respir. Crit. Care Med. 158 (1998) 1636). Their solutions are tested against published animal data from intravascular oxygen tension and saturation sensors. These equations provide one explanation for (i) observed physiological phenomena, such as within-breath fluctuations in arterial oxygen saturation and blood-gas tension; and (ii) conventional (time averaged) blood-gas sample oxygen tensions. We suggest that tidal-ventilation models are needed to describe within-breath fluctuations in arterial oxygen saturation and blood-gas tension in acute respiratory distress syndrome (ARDS) subjects. Both the amplitude of these oxygen saturation and tension fluctuations, and the mean oxygen blood-gas values, are affected by physiological variables such as inspired oxygen concentration, lung volume, and the inspiratory:expiratory (I:E) ratio, as well as by changes in pulmonary shunt during the respiratory cycle.

The effects of ventilation pattern on carbon dioxide transfer in three computer models of the airways.

We investigate the effects on arterial P(CO(2)) and on arterial-end tidal P(CO(2)) difference of six different ventilation patterns of equal tidal volume, and also of various combinations of tidal volume and respiratory rate that maintain a constant alveolar ventilation. We use predictions from three different mathematical models. Models 1 (distributed) and 2 (compartmental) include combined convection and diffusion effects. Model 3 incorporates a single well-mixed alveolar compartment and an anatomical dead-space in which plug flow occurs. We found that: (i) breathing patterns with longer inspiratory times yield lower arterial P(CO(2)); (ii) varying tidal volume and respiratory rate so that alveolar ventilation is kept constant may change both PA(CO(2)) and the PA(CO(2))-PET(CO(2)) difference; (iii) the distributed model predicts higher end-tidal and arterial P(CO(2)) than the compartmental models under similar conditions; and (iv) P(CO(2)) capnograms predicted by the distributed model exhibit longer phase I and steeper phase II than other models.

Periodic breathing induced by arterial oxygen partial pressure oscillations.

The Grodins model of respiratory control (Grodins et al., 1967) describes cardio-respiratory control for a lung with homogeneous gas concentrations. In this study we modify the Grodins model to take account of the inhomogeneities in gas concentration within the lung that are seen in many subjects with respiratory illnesses. This modification has the effect of lowering arterial oxygen partial pressure significantly. We investigate the effect on cardio-respiratory control of this low arterial oxygen signal and find that the governing equations may be reduced to a single delay-differential equation. This reduced model is found to be a good approximation to the full model and gives predictions that are similar to reported clinical data.

A flowing liquid test system for assessing the linearity and time-response of rapid fibre optic oxygen partial pressure sensors.

The development of a methodology for testing the time response, linearity and performance characteristics of ultra fast fibre optic oxygen sensors in the liquid phase is presented. Two standard medical paediatric oxygenators are arranged to provide two independent extracorporeal circuits. Flow from either circuit can be diverted over the sensor under test by means of a system of rapid cross-over solenoid valves exposing the sensor to an abrupt change in oxygen partial pressure, P O2. The system is also capable of testing the oxygen sensor responses to changes in temperature, carbon dioxide partial pressure P CO2 and pH in situ. Results are presented for a miniature fibre optic oxygen sensor constructed in-house with a response time ≈ 50 ms and a commercial fibre optic sensor (Ocean Optics Foxy), when tested in flowing saline and stored blood.

Design of a test system for fast time response fibre optic oxygen sensors.

A test system has been developed that can be used to calibrate and determine the time response, linearity and temperature sensitivity of a fibre optic oxygen sensor. The simple system obviates the need for precision gas standards and the requirement to generate a true square wave step response, which is seldom achievable. The sensor is mounted in a small chamber containing air or a known fraction of oxygen. By means of a computer-controlled switch, the absolute pressure within the chamber can be changed rapidly to a new steady state value. The partial pressure of oxygen changes in direct proportion to the absolute pressure, and so the accuracy and linearity and response time of the PO(2) calibration are limited only by those of the absolute pressure sensor. The temperature sensitivity of a commercial sensor and a means of correction are also described.

Variation of venous admixture, SF6 shunt, PaO2, and the PaO2/FIO2 ratio with FIO2.

BACKGROUND: Measures of impairment of oxygenation can be affected by the inspired oxygen fraction. METHODS: We used a mathematical model of an inhomogenous lung to predict the effect of increasing inspired oxygen concentration (FIO2) on: (1) venous admixture (Qva/Qt); (2) arterial oxygen partial pressure (PaO2); (3) the PaO2/FIO2 index of hypoxaemia; and (4) sulphur hexafluoride (SF6) retention (often taken to be true right-to-left shunt). This model predicts whether or not atelectasis will occur. RESULTS: For lungs with regions of low V/Q, increasing the inspired oxygen concentration can cause these regions to collapse. In the absence of atelectasis, the model predicts that Qva/Qt will decrease and arterial oxygen partial pressure increase as FIO2 is increased. However, when atelectasis occurs, Qva/Qt rises to a constant value, whilst PaO2 falls at first, but then begins to rise again, with increasing FIO2. The SF6 retention increased markedly in some cases at high FIO2. CONCLUSIONS: Venous admixture will estimate true right-to-left shunt at high FIO2, even when oxygen consumption is raised. This model can explain the way that the Pa/Fl ratio changes with increasing inspired oxygen concentration.