Volumetric capnography: lessons from the past and current clinical applications

Verscheure, Sara; Massion, Paul; Verschuren, Franck; Damas, Pierre; Magder, Sheldon

doi:10.1186/s13054-016-1377-3

Cited by 78 publications

(69 citation statements)

References 55 publications

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“…Volumetric capnography (Vcap) is also a novel tool which allows the measurement of physiological and alveolar dead space at the bedside 21– 23 . In this technique, expired CO 2 is plotted against the tidal volume for each breath.…”

Section: Advances In Optimization and Customization Of Mechanical Venmentioning

confidence: 99%

Recent Advances in Pediatric Ventilatory Assistance

et al. 2017

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In this review on respiratory assistance, we aim to discuss the following recent advances: the optimization and customization of mechanical ventilation, the use of high-frequency oscillatory ventilation, and the role of noninvasive ventilation. The prevention of ventilator-induced lung injury and diaphragmatic dysfunction is now a key aspect in the management of mechanical ventilation, since these complications may lead to higher mortality and prolonged length of stay in intensive care units. Different physiological measurements, such as esophageal pressure, electrical activity of the diaphragm, and volumetric capnography, may be useful objective tools to help guide ventilator assistance. Companies that design medical devices including ventilators and respiratory monitoring platforms play a key role in knowledge application. The creation of a ventilation consortium that includes companies, clinicians, researchers, and stakeholders could be a solution to promote much-needed device development and knowledge implementation.

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Section: Advances In Optimization and Customization Of Mechanical Venmentioning

confidence: 99%

Recent Advances in Pediatric Ventilatory Assistance

et al. 2017

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“…This appears difficult to interpret, but certainly should depend on ventilation inhomogeneity and the volume available for ventilation. Although the measure is not based on arterial CO 2 concentration, it appears to be closely related to alveolar dead space [26], which influences the lung volume accessible for gas exchange. Therefore, lung hyperinflation should play a role, and this was reflected by the fact that the parameter was linked to s3/s2 and s3.…”

Section: Ratio Area/volume Of Phasementioning

confidence: 99%

Correspondence between Capnovolumetric and Conventional Lung Function Parameters in the Diagnosis of Obstructive Airway Diseases

et al. 2020

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Background: Capnovolumetry is of interest as a method for the diagnosis of obstructive airway diseases, requiring little cooperation from the patient. Objective: To help in the interpretation of capnovolumetric parameters, we aimed to identify their correspondence to conventional lung function indices. Methods: We studied 978 patients from a diagnostic study with complete functional data and the clinical diagnosis of asthma, chronic obstructive pulmonary disease (COPD), or no respiratory disease. Using path analysis, four capnovolumetric parameters (slope of expiratory phase 3, ratio of slopes of phases 3 and 2, volume of phase 2, and the ratio area/volume of phase 3) previously identified as predictors of airway obstruction in terms of spirometry and body plethysmography, were analyzed regarding their relationship to each other and the diagnostic categories of asthma or COPD versus control, or obstruction versus no obstruction. We then identified four lung function parameters showing relationships as much as possible isomorphic to those between capnovolumetric parameters. Results: The four capnovolumetric parameters were related to COPD and obstruction via both direct and indirect influences, but only two of them to asthma. Regarding the correspondence to lung function parameters, the slope of expiratory phase 3 corresponded best to the ratio of residual volume to total lung capacity, the ratio of slopes of phases 3 and 2 to forced expiratory volume in 1 s, the volume of phase 2 to forced expired flow at 50% of vital capacity, and the ratio area/volume of phase 3 to forced vital capacity. Conclusions: Our results indicated an intricate relationship of capnovolumetric parameters to each other and to airway obstruction, asthma, or COPD. The correspondence to conventional lung function measures seemed to reflect the entities lung hyperinflation, overall ventilatory impairment, bronchoconstriction, and ventilated lung volume, in that order. These findings might be helpful for clinicians in the interpretation of capnovolumetry.

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“…This qualifies CO2 to be an early prognostic marker preceding the phosgene-induced acute lung edema. It could be speculated that an early surge of vasoconstrictive cytokines leaking from dysfunctional apoptotic/necrotic alveolar macrophages may have caused reduced perfusion of yet functional alveolar areas resulting in a higher retention of vascular CO2 at the expense of its reduced exhalation [26][27][28][29][30]. Depending on the disease condition, this secondary etiopathology can contribute to an elevated physiological dead space (Vd) and increase in overall ventilation-perfusion disturbances caused by ventilation delivered to non-perfused alveolar units.…”

Section: Ventilation Dead-spacementioning

confidence: 99%

Management of Phosgene-Induced Acute Lung Injury (ALI) by Personalized Protective PEEP-ECMO: What Can We Learn from Animal Bioassays?

Yang¹,

Yang²,

He³

2019

JICOA

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Background: Phosgene (carbonyl dichloride) gas is an indispensable chemical intermediate used in numerous industrial processes. Acute lung injury (ALI) caused by accidental inhalation exposure to phosgene is characterized pulmonary edema being phenotypically manifested after an asymptomatic or more precisely phrased “clinical occult” period. Opposite to common clinical practice, protective treatment should be given preference to curative treatment. Treatment initiated already during the asymptomatic phase shortly after exposure requires prognostic endpoints preceding the lung edema for triage and re-triage. Treatment strategies need to be personalized and exposure-dose related. The objective of this post-hoc analysis of published data is to assess prognostic value of ventilation dead-space (Vd/Vt) and extravascular lung water index (EVLWI) to guide treatment by protective PEEP supplemented by venovenous (vv) ECMO. Methods: This paper aims to compare the overarching published framework from systematic toxicological research of phosgene in animal bioassays with the clinical evidence from four accidentally phosgenepoisoned workers admitted to hospital with life-threatening lung edema. Treatment focused on a combination of protective PEEP and ECMO to reverse phosgene-induced deterioration in lung mechanics by personalized mechanical ventilation. Endpoints selected for titration PEEP focused on endpoints indicative of decoupling cardiopulmonary and vascular functions. To better understand any cardiogenic and vascular disturbances, titration endpoints included calculated ventilation dead-space (Vd/Vt), measured extravascular lung water index (EVLWI), arterial blood gases and acid-base status, systemic vascular resistance index (SVRI), and cardiac index (CI). EVLWI and APACHE II criteria guided the course of treatment in adjusting plateau pressure (Pplat), positive end-expiratory pressure (PEEP), and driving pressure (ΔP). Results: Remarkable equivalence of human data and those from controlled inhalation studies with phosgene on rats and dogs was found. The endpoint of choice guiding PEEP ventilation and implementation of ECMO was EVLWI. This maker of lung edema precisely reflects the increased wet lung weights in animals. Conclusions: ECMO-supplemented PEEP not only mitigates hypoxemia at conditions of severe ARDS and it also provides a means to reduce driving and plateau pressures minimizing ventilatorassociated lung injury.

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Volumetric capnography: lessons from the past and current clinical applications

Cited by 78 publications

References 55 publications

Recent Advances in Pediatric Ventilatory Assistance

Recent Advances in Pediatric Ventilatory Assistance

Correspondence between Capnovolumetric and Conventional Lung Function Parameters in the Diagnosis of Obstructive Airway Diseases

Management of Phosgene-Induced Acute Lung Injury (ALI) by Personalized Protective PEEP-ECMO: What Can We Learn from Animal Bioassays?

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