Volumetric capnography versus spirometry for the evaluation of pulmonary function in cystic fibrosis and allergic asthma

Almeida-Júnior, Armando A.; Marson, Fernando Augusto Lima; Almeida, Celize Cruz Bresciani; Ribeiro, Miguel; Paschoal, Ilma Aparecida; Moreira, Marcos Mello; Ribeiro, José Dirceu

doi:10.1016/j.jped.2018.10.008

Cited by 6 publications

(8 citation statements)

References 27 publications

(38 reference statements)

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“…As expected, SIII and KPIv were increased in CF patients. These findings are in line with previous studies, suggesting that classical VCap indices may be useful ventilation inhomogeneity markers in adults and children with CF [ 8 – 11 , 27 ]. In CF, ventilation inhomogeneity results in delayed CO 2 mixing within the conductive airways and, eventually, to non-homogeneous CO 2 exhalation ( i.e.…”

Section: Discussionsupporting

confidence: 93%

“…the SIII to SII ratio) increases respectively [ 8 ]. Thus, increased SIII and KPIv are consistent findings in CF [ 9 – 11 , 27 ], albeit their discriminative ability is moderate [ 11 ] and, in any case, inferior to that of the LCI [ 10 ]. Of note, the correlation between SIII and LCI or KPIv and LCI was rather weak.…”

Section: Discussionmentioning

confidence: 53%

“…The SIII reflects the rate of CO 2 exhalation beyond mid-expiration and is an unstandardised index that depends on the dynamics of expiration, especially on V E [ 12 – 14 ]. However, normalisation of SIII by V E [ 11 ] is not justified, because as shown in previous studies [ 12 – 14 ] and confirmed in ours ( figure 4a , supplementary figure S3A ), the SIII– V E relationship is not linear. SIII normalisation by the F ECO 2 ( i.e.…”

Section: Discussionmentioning

confidence: 66%

“…Volumetric capnography is a simple noninvasive technique that does not require complex respiratory manoeuvres, exogenous gases, extensive signal processing or operator's expertise [ 2 , 5 , 7 ]. Current evidence suggests that classical VCap indices, such as SIII and KPIv, may be sensitive markers of early lung changes in patients with CF [ 11 ]; however, their diagnostic performance is limited due to the strong dependence on breathing dynamics [ 12 – 14 ]. Our results indicate that novel CIIs have lower variability compared to classical VCap indices, thus suggesting that they may be less influenced by the breathing pattern; however, further studies are needed to clarify this important issue.…”

Section: Discussionmentioning

confidence: 99%

“…The volume-based capnogram is the plot of CO 2 concentration against the exhaled air volume and consists of three phases: phase I represents the washout of the uppermost conductive airways that contain atmospheric – CO 2 -free – air; phase II is characterised by a steep CO 2 rise and reflects the mixing between atmospheric air and CO 2 -rich gas from the alveolar compartment; and phase III, the so-called “alveolar plateau”, represents the expiration of alveolar gas. Volumetric capnography allows for the assessment of dead space ventilation and ventilation–perfusion abnormalities [ 2 – 7 ], while the slope of phase III (SIII) is considered an index of ventilation inhomogeneity in obstructive lung disorders, such as cystic fibrosis (CF) [ 7 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Novel volumetric capnography indices measure ventilation inhomogeneity in cystic fibrosis

et al. 2022

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BackgroundVolumetric capnography (VCap) is a simpler alternative of multiple-breath washout (MBW) to detect ventilation inhomogeneity (VI) in patients with cystic fibrosis (CF). However, its diagnostic performance is influenced by breathing dynamics. We introduce two novel VCap indices, the Capnographic Inhomogeneity Indices (CIIs) that may overcome this limitation and explore their diagnostic characteristics in a cohort of CF patients.MethodsWe analysed 320 N2-MBW trials from 50 CF patients and 65 controls (age 4-18 years) and calculated classical VCap indices, such as slope III (SIII) and the capnographic index (KPIv). We introduced novel CIIs based on a theoretical lung model, and assessed their diagnostic performance compared to classical VCap indices and the lung clearance index (LCI).ResultsBoth CIIs were significantly higher in CF patients compared with controls (mean±SD CII1 5.9±1.4% versus 5.1±1.0%, p=0.002; CII2 7.7±1.8% versus 6.8±1.4%, p=0.002) and presented strong correlation with LCI (CII1 R2=0.47 and CII2 R2=0.44 in CF patients). Classical VCap indices showed inferior discriminative ability (SIII 2.3±1.0%/L versus 1.9±0.7%/L, P=0.013; KPIv 3.9±1.3% versus 3.5±1.2%, P=0.071), while the correlation with LCI was weak (SIII R2=0.03; KPIv R2=0.08 in CF patients). CIIs showed lower intra-subject inter-trial variability, calculated as coefficient of variation for three and relative difference for two trials, than classical VCap indices, but higher than LCI (CII1 11.1±8.2% and CII2 11.0±8.0% versus SIII 16.3±13.5%; KPIv 15.9±12.8%; LCI 5.9%±4.2%).ConclusionCIIs detect VI better than classical VCap indices and correlate well with LCI. However, further studies on their diagnostic performance and clinical utility are required.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Novel volumetric capnography indices measure ventilation inhomogeneity in cystic fibrosis

et al. 2022

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Monitoring the Resolution of Acute Exacerbation of Airway Bronchoconstriction in an Asthma Attack Using Capnogram Waveforms

Shikama

Yamamoto

Osawa

et al. 2023

Critical Care Explorations

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BACKGROUND:Patients with acute bronchospasm can show a distinct slope of the capnogram ("shark fin") as a result of asynchronous alveolar excretion. Although the slope of the upward alveolar plateau (phase III) in the capnogram waveforms of non-intubated patients is known to help monitor the therapeutic response to acute bronchospasm, little is known about the significance of its slope among intubated patients. Therefore, we quantified the phase III slope of an intubated patient with acute asthma to investigate whether capnogram waveforms could be useful for identifying the response to antibronchospasm treatment in real time.

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Immediate effects of the incentive spirometer in women with healthy voice

Lopes,

Korn,

Nunes

et al. 2024

CoDAS

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Purpose To evaluate the immediate effect of the incentive spirometer on acoustic measures, aerodynamic measures and on the auditory-perceptual assessment of vocal quality in vocally healthy women. Methods This is an experimental intra-subject comparison study with the participation of 22 women without vocal complaints. Acoustic measures, aerodynamic measures and auditory-perceptual assessment of vocal quality were obtained before and immediately after using the incentive spirometer by the participants. The device was used in the orthostatic position and the participants performed three sets of ten repetitions with a one-minute interval between sets. Results After using the incentive spirometer, there was a significant reduction in jitter, shimmer and PPQ (period perturbation quotient) measurements and an increase in maximum expiratory volume, while the other acoustic and aerodynamic measurements were not significantly impacted. In addition, there was improvement in vocal quality in eight (36.4%) participants and 11 (50.0%) participants showed no changes in the auditory perceptual assessment of voice quality after using the incentive spirometer. Conclusion The use of the incentive spirometer is safe and, in its immediate effect, positively impacts the acoustic measures of short-term aperiodicity of frequency and intensity and increases the maximum expiratory volume in women with healthy voices.

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Volumetric capnography versus spirometry for the evaluation of pulmonary function in cystic fibrosis and allergic asthma

Cited by 6 publications

References 27 publications

Novel volumetric capnography indices measure ventilation inhomogeneity in cystic fibrosis

Novel volumetric capnography indices measure ventilation inhomogeneity in cystic fibrosis

Monitoring the Resolution of Acute Exacerbation of Airway Bronchoconstriction in an Asthma Attack Using Capnogram Waveforms

Immediate effects of the incentive spirometer in women with healthy voice

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