Capnodynamic determination of end-expiratory lung volume in a porcine model of hypoxic pulmonary vasoconstriction

TL;DR

This study tests a CO2-based method for measuring lung volume in pigs under hypoxia and finds it generally reliable, though hypoxia and nitric oxide temporarily affect accuracy.

Contribution

The study evaluates the capnodynamic method under hypoxia and nitric oxide, conditions not previously examined.

Findings

EELV-CO2 showed a small bias and consistent agreement with EELV-SF6 under normal and hypoxic conditions.

Agreement was temporarily impaired during nitric oxide exposure but stabilized with normoxemia.

The capnodynamic method remains viable for EELV estimation despite hypoxia and vasoconstriction.

Abstract

The capnodynamic method, End Expiratory Lung Volume CO2 (EELV-CO2), utilizes exhaled carbon dioxide analysis to estimate End-Expiratory Lung Volume (EELV) and has been validated in both normal lungs and lung injury models. Its performance under systemic hypoxia and variations in CO2 elimination is not examined. This study aims to validate EELV-CO2 against inert gas wash in/wash out (EELV- SF6, sulfur hexafluoride) in a porcine model of stable hemodynamic conditions followed by hypoxic pulmonary vasoconstriction and inhaled nitric oxide (iNO).

Ten mechanically ventilated piglets were exposed to a hypoxic gas mixture and selective pulmonary vasoconstriction. Inhalation of nitric oxide was used to reverse the pulmonary vasoconstriction. Paired recordings of EELV-CO2 and EELV-SF6, were conducted to assess their agreement of absolute values.

EELV-CO2 showed a bias of + 5 ml kg− 1 compared to EELV-SF6, upper limit of agreement of 11 ml kg− 1 (95%CI: 9–13 ml kg− 1), lower limit of agreement − 1 ml kg− 1 (95%CI: -3- 0 ml kg− 1), mean percentage error 34%. Agreement between EELV-CO2 and EELV-SF6 was largely constant but was affected by progressing hypoxia and reached maximum limit of agreement after iNO exposure. Re-introduction of normoxemia then stabilized bias and limits of agreement to baseline levels.

EELV-CO2 generates absolute values in parallel with EELV -SF6. Stressing EELV-CO2 with hypoxic pulmonary vasoconstriction and iNO, transiently impairs the agreement which stabilizes once normoxemia is reestablished.

The online version contains supplementary material available at 10.1007/s10877-024-01251-1.

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