Sources of error in partial rebreathing pulmonary blood flow measurements in lungs with emphysema and pulmonary embolism
Studies of the accuracy of partial rebreathing measurements of pulmonary blood flow (PBF) in patients with abnormal lungs have not fully explained the sources of error. We used computer models of emphysema and pulmonary embolism incorporating both ventilation-perfusion ( V˙/ Q˙) and ventilation-volu...
Gespeichert in:
| Veröffentlicht in: | British journal of anaesthesia : BJA 2006-11, Vol.97 (5), p.732-741 |
|---|---|
| Hauptverfasser: | , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 741 |
|---|---|
| container_issue | 5 |
| container_start_page | 732 |
| container_title | British journal of anaesthesia : BJA |
| container_volume | 97 |
| creator | Yem, J.S. Turner, M.J. Baker, A.B. |
| description | Studies of the accuracy of partial rebreathing measurements of pulmonary blood flow (PBF) in patients with abnormal lungs have not fully explained the sources of error.
We used computer models of emphysema and pulmonary embolism incorporating both ventilation-perfusion ( V˙/ Q˙) and ventilation-volume ( V˙/V) heterogeneity to investigate systematic errors in partial rebreathing PBF measurements. We studied (i) errors produced under usual conditions, (ii) effects of recirculation, (iii) effects of alveolar–proximal airway and alveolar-capillary Pco2 and V˙CO2 differences, (iv) effects of alveolar V˙/ Q˙ inhomogeneity and (v) effects of rebreathing time.
In the pulmonary embolism model the systematic error is only acceptable ( |
| doi_str_mv | 10.1093/bja/ael214 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_68944268</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0007091217353795</els_id><sourcerecordid>1218680621</sourcerecordid><originalsourceid>FETCH-LOGICAL-c461t-5047cc9cce6639af652f2c39ad63b3fbec8a0b605ee7c1c07766a134abbf7b493</originalsourceid><addsrcrecordid>eNpt0VtrFDEUAOAgil2rL_4ACYJ9EMYmM5lk51GKbS0FH6xUfAlJ5kw3ay7TZMa2_94ss1gRIZBAvnM4F4ReU_KBkq451lt1rMDVlD1BK8oErbgQ9ClaEUJERTpaH6AXOW8JoaLu2ufogPKu5lSQFbr_GudkIOM4YEgpJmwDHlWarHI4gU6gpo0NN3icnY9BpQesXYw9Hly8wx5UnhN4CFPeBbo53GR8Z6cNBj9uHjJ4hVXo_4oGr6Oz2b9EzwblMrza34fo2-mnq5Pz6vLL2eeTj5eVYZxOVUuYMKYzBjhvOjXwth5qU149b3QzaDBrRTQnLYAw1BAhOFe0YUrrQWjWNYfoaMk7png7Q56kt9mAcypAnLPk646xmq8LfPsP3JbRhFKbpJ0QbdO0pKD3CzIp5pxgkGOyvvQlKZG7ZciyDLkso-A3-4yz9tA_0v30C3i3Byob5YakgrH50a1rVs6uh2pxNk9w_-dfpZ-Si0a08vz7D0ku2PXFWXclr4tni4cy2F8WkszGQjDQ2wRmkn20_6v3N8jMtxc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>197753350</pqid></control><display><type>article</type><title>Sources of error in partial rebreathing pulmonary blood flow measurements in lungs with emphysema and pulmonary embolism</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Yem, J.S. ; Turner, M.J. ; Baker, A.B.</creator><creatorcontrib>Yem, J.S. ; Turner, M.J. ; Baker, A.B.</creatorcontrib><description>Studies of the accuracy of partial rebreathing measurements of pulmonary blood flow (PBF) in patients with abnormal lungs have not fully explained the sources of error.
We used computer models of emphysema and pulmonary embolism incorporating both ventilation-perfusion ( V˙/ Q˙) and ventilation-volume ( V˙/V) heterogeneity to investigate systematic errors in partial rebreathing PBF measurements. We studied (i) errors produced under usual conditions, (ii) effects of recirculation, (iii) effects of alveolar–proximal airway and alveolar-capillary Pco2 and V˙CO2 differences, (iv) effects of alveolar V˙/ Q˙ inhomogeneity and (v) effects of rebreathing time.
In the pulmonary embolism model the systematic error is only acceptable (<10%) when the simulated PBF is low (2–3 litre min−1). In the emphysema model PBF is underestimated by more than 20% at all cardiac outputs studied. Four sources of systematic errors were found. (i) Alveolar–proximal airway Pco2 gradients and flux differences between the proximal airway and alveolar compartments contribute most to the systematic error. (ii) V˙/ Q˙ inhomogeneity causes Pco2 gradients between the alveolar compartments and pulmonary capillary blood, and between pulmonary capillary compartments. (iii) Rebreathing times are inadequate in the presence of V˙/V mismatch. (iv) The apparent effect of venous blood recirculation is small in emphysema but significant in pulmonary embolism.
We conclude that PBF cannot be measured accurately by partial rebreathing in lungs with emphysema or embolism. Systematic errors are caused mainly by errors in end-tidal Pco2 values.</description><identifier>ISSN: 0007-0912</identifier><identifier>EISSN: 1471-6771</identifier><identifier>DOI: 10.1093/bja/ael214</identifier><identifier>PMID: 16926170</identifier><identifier>CODEN: BJANAD</identifier><language>eng</language><publisher>Oxford: Elsevier Ltd</publisher><subject>Aged ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Breath Tests - methods ; Carbon Dioxide - blood ; Cardiac Output ; complications ; complications, error ; Computer Simulation ; disease ; error ; Female ; heart ; heart, cardiac output ; Humans ; lung ; lung, disease ; lung, rebreathing ; Male ; Medical sciences ; Middle Aged ; Models, Biological ; Partial Pressure ; Pulmonary Alveoli - physiopathology ; Pulmonary Circulation ; Pulmonary Embolism - physiopathology ; Pulmonary Emphysema - physiopathology ; rebreathing ; Ventilation-Perfusion Ratio</subject><ispartof>British journal of anaesthesia : BJA, 2006-11, Vol.97 (5), p.732-741</ispartof><rights>2006 British Journal of Anaesthesia</rights><rights>2007 INIST-CNRS</rights><rights>Copyright Oxford University Press(England) Nov 2006</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c461t-5047cc9cce6639af652f2c39ad63b3fbec8a0b605ee7c1c07766a134abbf7b493</citedby><cites>FETCH-LOGICAL-c461t-5047cc9cce6639af652f2c39ad63b3fbec8a0b605ee7c1c07766a134abbf7b493</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18248249$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16926170$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yem, J.S.</creatorcontrib><creatorcontrib>Turner, M.J.</creatorcontrib><creatorcontrib>Baker, A.B.</creatorcontrib><title>Sources of error in partial rebreathing pulmonary blood flow measurements in lungs with emphysema and pulmonary embolism</title><title>British journal of anaesthesia : BJA</title><addtitle>Br J Anaesth</addtitle><description>Studies of the accuracy of partial rebreathing measurements of pulmonary blood flow (PBF) in patients with abnormal lungs have not fully explained the sources of error.
We used computer models of emphysema and pulmonary embolism incorporating both ventilation-perfusion ( V˙/ Q˙) and ventilation-volume ( V˙/V) heterogeneity to investigate systematic errors in partial rebreathing PBF measurements. We studied (i) errors produced under usual conditions, (ii) effects of recirculation, (iii) effects of alveolar–proximal airway and alveolar-capillary Pco2 and V˙CO2 differences, (iv) effects of alveolar V˙/ Q˙ inhomogeneity and (v) effects of rebreathing time.
In the pulmonary embolism model the systematic error is only acceptable (<10%) when the simulated PBF is low (2–3 litre min−1). In the emphysema model PBF is underestimated by more than 20% at all cardiac outputs studied. Four sources of systematic errors were found. (i) Alveolar–proximal airway Pco2 gradients and flux differences between the proximal airway and alveolar compartments contribute most to the systematic error. (ii) V˙/ Q˙ inhomogeneity causes Pco2 gradients between the alveolar compartments and pulmonary capillary blood, and between pulmonary capillary compartments. (iii) Rebreathing times are inadequate in the presence of V˙/V mismatch. (iv) The apparent effect of venous blood recirculation is small in emphysema but significant in pulmonary embolism.
We conclude that PBF cannot be measured accurately by partial rebreathing in lungs with emphysema or embolism. Systematic errors are caused mainly by errors in end-tidal Pco2 values.</description><subject>Aged</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Breath Tests - methods</subject><subject>Carbon Dioxide - blood</subject><subject>Cardiac Output</subject><subject>complications</subject><subject>complications, error</subject><subject>Computer Simulation</subject><subject>disease</subject><subject>error</subject><subject>Female</subject><subject>heart</subject><subject>heart, cardiac output</subject><subject>Humans</subject><subject>lung</subject><subject>lung, disease</subject><subject>lung, rebreathing</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Models, Biological</subject><subject>Partial Pressure</subject><subject>Pulmonary Alveoli - physiopathology</subject><subject>Pulmonary Circulation</subject><subject>Pulmonary Embolism - physiopathology</subject><subject>Pulmonary Emphysema - physiopathology</subject><subject>rebreathing</subject><subject>Ventilation-Perfusion Ratio</subject><issn>0007-0912</issn><issn>1471-6771</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpt0VtrFDEUAOAgil2rL_4ACYJ9EMYmM5lk51GKbS0FH6xUfAlJ5kw3ay7TZMa2_94ss1gRIZBAvnM4F4ReU_KBkq451lt1rMDVlD1BK8oErbgQ9ClaEUJERTpaH6AXOW8JoaLu2ufogPKu5lSQFbr_GudkIOM4YEgpJmwDHlWarHI4gU6gpo0NN3icnY9BpQesXYw9Hly8wx5UnhN4CFPeBbo53GR8Z6cNBj9uHjJ4hVXo_4oGr6Oz2b9EzwblMrza34fo2-mnq5Pz6vLL2eeTj5eVYZxOVUuYMKYzBjhvOjXwth5qU149b3QzaDBrRTQnLYAw1BAhOFe0YUrrQWjWNYfoaMk7png7Q56kt9mAcypAnLPk646xmq8LfPsP3JbRhFKbpJ0QbdO0pKD3CzIp5pxgkGOyvvQlKZG7ZciyDLkso-A3-4yz9tA_0v30C3i3Byob5YakgrH50a1rVs6uh2pxNk9w_-dfpZ-Si0a08vz7D0ku2PXFWXclr4tni4cy2F8WkszGQjDQ2wRmkn20_6v3N8jMtxc</recordid><startdate>20061101</startdate><enddate>20061101</enddate><creator>Yem, J.S.</creator><creator>Turner, M.J.</creator><creator>Baker, A.B.</creator><general>Elsevier Ltd</general><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>6I.</scope><scope>AAFTH</scope><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20061101</creationdate><title>Sources of error in partial rebreathing pulmonary blood flow measurements in lungs with emphysema and pulmonary embolism</title><author>Yem, J.S. ; Turner, M.J. ; Baker, A.B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c461t-5047cc9cce6639af652f2c39ad63b3fbec8a0b605ee7c1c07766a134abbf7b493</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Aged</topic><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Breath Tests - methods</topic><topic>Carbon Dioxide - blood</topic><topic>Cardiac Output</topic><topic>complications</topic><topic>complications, error</topic><topic>Computer Simulation</topic><topic>disease</topic><topic>error</topic><topic>Female</topic><topic>heart</topic><topic>heart, cardiac output</topic><topic>Humans</topic><topic>lung</topic><topic>lung, disease</topic><topic>lung, rebreathing</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Models, Biological</topic><topic>Partial Pressure</topic><topic>Pulmonary Alveoli - physiopathology</topic><topic>Pulmonary Circulation</topic><topic>Pulmonary Embolism - physiopathology</topic><topic>Pulmonary Emphysema - physiopathology</topic><topic>rebreathing</topic><topic>Ventilation-Perfusion Ratio</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yem, J.S.</creatorcontrib><creatorcontrib>Turner, M.J.</creatorcontrib><creatorcontrib>Baker, A.B.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of anaesthesia : BJA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yem, J.S.</au><au>Turner, M.J.</au><au>Baker, A.B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sources of error in partial rebreathing pulmonary blood flow measurements in lungs with emphysema and pulmonary embolism</atitle><jtitle>British journal of anaesthesia : BJA</jtitle><addtitle>Br J Anaesth</addtitle><date>2006-11-01</date><risdate>2006</risdate><volume>97</volume><issue>5</issue><spage>732</spage><epage>741</epage><pages>732-741</pages><issn>0007-0912</issn><eissn>1471-6771</eissn><coden>BJANAD</coden><abstract>Studies of the accuracy of partial rebreathing measurements of pulmonary blood flow (PBF) in patients with abnormal lungs have not fully explained the sources of error.
We used computer models of emphysema and pulmonary embolism incorporating both ventilation-perfusion ( V˙/ Q˙) and ventilation-volume ( V˙/V) heterogeneity to investigate systematic errors in partial rebreathing PBF measurements. We studied (i) errors produced under usual conditions, (ii) effects of recirculation, (iii) effects of alveolar–proximal airway and alveolar-capillary Pco2 and V˙CO2 differences, (iv) effects of alveolar V˙/ Q˙ inhomogeneity and (v) effects of rebreathing time.
In the pulmonary embolism model the systematic error is only acceptable (<10%) when the simulated PBF is low (2–3 litre min−1). In the emphysema model PBF is underestimated by more than 20% at all cardiac outputs studied. Four sources of systematic errors were found. (i) Alveolar–proximal airway Pco2 gradients and flux differences between the proximal airway and alveolar compartments contribute most to the systematic error. (ii) V˙/ Q˙ inhomogeneity causes Pco2 gradients between the alveolar compartments and pulmonary capillary blood, and between pulmonary capillary compartments. (iii) Rebreathing times are inadequate in the presence of V˙/V mismatch. (iv) The apparent effect of venous blood recirculation is small in emphysema but significant in pulmonary embolism.
We conclude that PBF cannot be measured accurately by partial rebreathing in lungs with emphysema or embolism. Systematic errors are caused mainly by errors in end-tidal Pco2 values.</abstract><cop>Oxford</cop><pub>Elsevier Ltd</pub><pmid>16926170</pmid><doi>10.1093/bja/ael214</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0007-0912 |
| ispartof | British journal of anaesthesia : BJA, 2006-11, Vol.97 (5), p.732-741 |
| issn | 0007-0912 1471-6771 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_68944268 |
| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Aged Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Breath Tests - methods Carbon Dioxide - blood Cardiac Output complications complications, error Computer Simulation disease error Female heart heart, cardiac output Humans lung lung, disease lung, rebreathing Male Medical sciences Middle Aged Models, Biological Partial Pressure Pulmonary Alveoli - physiopathology Pulmonary Circulation Pulmonary Embolism - physiopathology Pulmonary Emphysema - physiopathology rebreathing Ventilation-Perfusion Ratio |
| title | Sources of error in partial rebreathing pulmonary blood flow measurements in lungs with emphysema and pulmonary embolism |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-29T07%3A40%3A29IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Sources%20of%20error%20in%20partial%20rebreathing%20pulmonary%20blood%20flow%20measurements%20in%20lungs%20with%20emphysema%20and%20pulmonary%20embolism&rft.jtitle=British%20journal%20of%20anaesthesia%20:%20BJA&rft.au=Yem,%20J.S.&rft.date=2006-11-01&rft.volume=97&rft.issue=5&rft.spage=732&rft.epage=741&rft.pages=732-741&rft.issn=0007-0912&rft.eissn=1471-6771&rft.coden=BJANAD&rft_id=info:doi/10.1093/bja/ael214&rft_dat=%3Cproquest_cross%3E1218680621%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=197753350&rft_id=info:pmid/16926170&rft_els_id=S0007091217353795&rfr_iscdi=true |