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PubMed1978

A theoretical analysis of the barometric method for measurement of tidal volume.

The barometric method is unique in allowing measurement of tidal volume in a manner that requires no tactile contact with the subject. The equations used by previous investigators to calculate tidal volume described only events occurring during inspiration. Neglect of events during expiration caused a systematic error. Additional equations needed to calculate tidal volume for the barometric method are derived. An error sensitivity analysis is performed to assess quantitatively the accuracy of the calculated tidal volume due to propagation of errors in the experimentally measured variables. Numberical evaluation for typical cases indicates that the limit of accuracy for tidal volume measurement lies between 10 and 15%.

Humans↗

PubMed1989

The effect of tidal volume and intravascular volume state on systolic pressure variation in ventilated dogs.

Both tidal volume and effective blood volume may affect the variation in the arterial pressure waveform during mechanical ventilation. The systolic pressure variation (SPV), which is the difference between the maximal and minimal systolic pressure values following one positive pressure breath was analyzed in 10 anesthetized and ventilated dogs, during ventilation with tidal volumes of 15 and 25 ml/kg. The dogs were studied during normovolemia, hypovolemia (after bleeding of 30% of estimated blood volume) and hypervolemia (after retransfusion of shed blood with additional 50 ml/kg of plasma expander). The SPV reflected hemodynamic changes and was maximal during hypovolemia and minimal during hypervolemia. Unlike all other hemodynamic parameters it was also affected by the tidal volume and significantly increased at higher tidal volumes during each volume state. We conclude that the SPV and its components are useful parameters in evaluating the intravascular volume state. They also reflect the magnitude of the tidal volume employed.

Animals↗

PubMed1998

Increasing tidal volumes and pulmonary overdistention adversely affect pulmonary vascular mechanics and cardiac output in a pediatric swine model.

OBJECTIVES: In a pediatric swine model, the effects of increasing tidal volumes and the subsequent development of pulmonary overdistention on cardiopulmonary interactions were studied. The objective was to test the hypothesis that increasing tidal volumes adversely affect pulmonary vascular mechanics and cardiac output. An additional goal was to determine whether the effects of pulmonary overdistention are dependent on delivered tidal volume and/or positive end-expiratory pressure (PEEP, end-expiratory lung volume). DESIGN: Prospective, randomized, controlled laboratory trial. SETTING: University research laboratory. SUBJECTS: Eleven 4- to 6-wk-old swine, weighing 8 to 12 kg. INTERVENTIONS: Piglets with normal lungs were anesthetized, intubated, and paralyzed. After median sternotomy, pressure transducers were placed in the right ventricle, pulmonary artery, and left atrium. An ultrasonic flow probe was placed around the pulmonary artery. MEASUREMENTS AND MAIN RESULTS: The swine were ventilated and data were collected with delivered tidal volumes of 10, 15, 20, and 25 mL/kg and PEEP settings of 5 and 10 cm H2O in a random order. Pulmonary overdistention was defined as a decrease in dynamic compliance of > or =20% when compared with a compliance measured at a baseline tidal volume of 10 mL/kg. At this baseline tidal volume, airway pressure-volume curves did not demonstrate pulmonary overdistention. Tidal volumes and airway pressures were measured by a pneumotachometer and the Pediatric Pulmonary Function Workstation. Inspiratory time (0.75 sec), FIO2 (0.3), and minute ventilation were held constant. We evaluated the pulmonary vascular and cardiac effects of the various tidal volume and PEEP settings by measuring pulmonary vascular resistance, pulmonary characteristic impedance, and cardiac output. When compared with a tidal volume of 10 mL/kg, a tidal volume of 20 mL/kg resulted in a significant decrease in dynamic compliance from 10.5 +/- 0.9 to 8.4 +/- 0.6 mL/cm H2O (p = .02) at a constant PEEP of 5 cm H2O. The decrease in dynamic compliance of 20% indicated the presence of pulmonary overdistention by definition. As the tidal volume was increased from 10 to 20 mL/kg, pulmonary vascular resistance (1351 +/- 94 vs. 2266 +/- 233 dyne x sec/cm5; p = .004) and characteristic impedance (167 +/- 12 vs. 219 +/- 22 dyne x sec/cm5; p = .02) significantly increased, while cardiac output significantly decreased (951 +/- 61 vs. 708 +/- 48 mL/min; p = .001). Each of these effects of pulmonary overdistention were further magnified when the tidal volume was increased to 25 mL/kg. The tidal volume-induced alterations in pulmonary vascular mechanics, characteristic impedance, and cardiac output occurred to a greater degree when the PEEP was increased to 10 cm H2O. Pulmonary vascular resistance and characteristic impedance were significantly increased and cardiac output significantly decreased for all tidal volumes studied at a PEEP of 10 cm H2O as compared with 5 cm H2O. CONCLUSIONS: Increasing tidal volumes, increasing PEEP levels, and the development of pulmonary overdistention had detrimental effects on the cardiovascular system by increasing pulmonary vascular resistance and characteristic impedance while significantly decreasing cardiac output. Delivered tidal volumes of >15 mL/kg should be utilized cautiously. Careful monitoring of respiratory mechanics and cardiac function, especially in neonatal and pediatric patients, is warranted.

Animals↗

PubMed1991

[Mechanical ventilation in an anesthetic circle system using the lowest tidal volume--studies of 3 anesthesia ventilators in a lung model and an animal experiment].

No anesthesia ventilator attached to a circle system is manufactured for use in neonates. However, a small bellows can be supplied for the following anesthesia ventilators: Spiromat NS 656 (NS), Ventilog 2 (V2) and AV1 (Draeger Co.) We investigated the minimal tidal volume delivered by each of the three ventilators. In addition, we tested the performance of the AV1 in neonatal piglets for manual and controlled ventilation, and in decreased lung compliance. MATERIALS AND METHODS. All circuits were equipped with one CO2 canister (750 ml) and the low-compliance tubes of the "Ulmer Kinder Set" (Ruesch Co.) The circuits were connected to a lung model consisting of a glass cylinder filled with copper wool with a compliance of 3.0 ml/mbar. By using calibrated glass syringes we created a pressure-volume correlation for the entire system, i.e., the lung model, the anesthesia circuit and the ventilator, which was linear for each of the three ventilators. The pressure was measured in the test lung. The pressure increase caused by the tidal volume therefore reflected the actual tidal volume delivered, which was calculated using the pressure-volume correlation. Tidal volumes were determined for varying the fresh gas flow (FGF), the respiratory rate (RR), which was varied between 20 and 60/min and the I:E ratio (IE), which was varied between 1:1 and 1:2. Six newborn piglets aged 2-12 h and with body weight 1000-1300 g were anesthetized, tracheotomized and ventilated with an oxygen-nitrous oxide mixture (FIO2 0.25). The manual ventilation lasted 30 min (period 1) and was followed by mechanical ventilation for 60 min (period 2). Thereafter, a left pneumothorax with constant pressure of 20 mbar and then 40 mbar for 15 min each was created (period 3). A fall in blood pressure was treated with 10 ml colloids in five of the six animals. During the experiment arterial blood pressure in the carotid artery, mean airway pressure at the distal end of the tracheal tube and end-tidal CO2 were continuously recorded. Arterial blood gases were analyzed at the end of each period. RESULTS. The tidal volumes delivered with an identical position of the bellows varied in ventilators NS and V2 with changes in FGF, RR and IE. Decrease in FGF, higher RR and longer expiration resulted in a decrease in the tidal volume. The "smallest" tidal volume delivered by NS varied from 50 ml (FGF 2 l/min, RR 60, IE 1:2) to 188 ml (FGF 4 l/min, RR 20, IE 1:1) and from 11 ml (FGF 2 l/min, RR 60, IE 1:2) to 110 (FGF 4 l/min, RR 20, IE 1:1) in the V2. The AV1 showed a minimal tidal volume of about 5 ml, and no changes in tidal volume attributable to alterations in FGF, RR or IE could be observed. No problems occurred during manual or mechanical ventilation in the piglets. With the experimental decrease in lung compliance no increase in airway pressure was noted, but an increase in arterial pCO2 by 8 mmHg (mean) reflects hypoventilation that was not corrected by the ventilator. DISCUSSION. We believe that the changes in tidal volume in ventilators NS and V2 are caused by adding FGF to the volume delivered by the below during inspiration. Because of the unpredictability of the tidal volumes, these ventilators are not suitable for the use in neonates. The AV1 has a very low systemic compliance which makes it suitable for use in neonatal anesthesia. However, a decrease in lung compliance is not compensated by an increase in airway pressure and leads to hypoventilation. When small tidal volumes are used in patients with low lung compliance, it does not act as expected of a volume-cycled ventilator.

Anesthesiology↗

PubMed1990

Influence of tidal volume on histamine-induced bronchoconstriction in guinea pigs.

The effects of tidal volume amplitude on bronchopulmonary reactivity were investigated in three groups of 14 anesthetized paralyzed mechanically ventilated guinea pigs. Animals of group 1 served as control; in animals of group 2, both the sympathetic and parasympathetic nervous systems were blocked; in animals of group 3, only the parasympathetic system was blocked. In each group, the animals were randomly divided into two subgroups characterized by their ventilatory pattern: rate of 60/min with a 6-ml/kg tidal volume or rate of 40/min with a 9-ml/kg tidal volume. Bronchopulmonary reactivity to infused histamine was assessed by the respiratory compliance and conductance values measured during bronchoconstriction and expressed as a percentage of the corresponding basal values. In group 1 the animals ventilated with a 9-ml/kg tidal volume were found significantly less reactive than those ventilated with a 6-ml/kg tidal volume. This difference was abolished in groups 2 and 3. These results demonstrate that the effects of increased tidal volume on bronchopulmonary reactivity are vagally mediated and suggest that the decrease observed in histamine-induced bronchoconstriction is mainly due to reflex effects evoked by stretch receptor stimulation.

Animals↗

PubMed1993

Comparison of tidal volumes obtained by one-handed and two-handed ventilation techniques.

OBJECTIVES: To compare tidal volumes delivered by one- vs two-handed compressions of a manual resuscitation bag and assess the effects of subject characteristics on those tidal volumes. DESIGN: Subjects (108 healthcare providers from a 500-bed teaching hospital) were assigned randomly to one of two procedures: one- followed by two-handed compression or two- followed by one-handed compression. A 1-liter resuscitation bag, lung performance analyzer and Wright spirometer were used to measure tidal volume. Data collection occurred in a simulated situation. RESULTS: There was a significant difference in tidal volume delivered by one-handed (mean = 694 mL, SD = 111) vs two-handed compressions (mean = 827 mL, SD = 113). Hand size, grip strength, height and weight were correlated with tidal volumes generated by one-handed and two-handed procedures. No other subject characteristics were correlated with tidal volumes. CONCLUSIONS: Tidal volumes delivered by healthcare providers using one- vs two-handed compressions were found to be significantly different, with those delivered by two hands significantly greater than those delivered by one hand. Strength of hand grip was the best predictor of volume delivered and was more strongly correlated with volumes delivered by one rather than two hands.

Female↗

PubMed2004

Effect of lung compliance and endotracheal tube leakage on measurement of tidal volume.

INTRODUCTION: The objective of this laboratory study was to measure the effect of decreased lung compliance and endotracheal tube (ETT) leakage on measured exhaled tidal volume at the airway and at the ventilator, in a research study with a test lung. METHODS: The subjects were infant, adult and pediatric test lungs. In the test lung model, lung compliances were set to normal and to levels seen in acute respiratory distress syndrome. Set tidal volume was 6 ml/kg across a range of simulated weights and ETT sizes. Data were recorded from both the ventilator light-emitting diode display and the CO2SMO Plus monitor display by a single observer. Effective tidal volume was calculated from a standard equation. RESULTS: In all test lung models, exhaled tidal volume measured at the airway decreased markedly with decreasing lung compliance, but measurement at the ventilator showed minimal change. In the absence of a simulated ETT leak, calculation of the effective tidal volume led to measurements very similar to exhaled tidal volume measured at the ETT. With a simulated ETT tube leak, the effective tidal volume markedly overestimated tidal volume measured at the airway. CONCLUSION: Previous investigators have emphasized the need to measure tidal volume at the ETT for all children. When ETT leakage is minimal, it seems from our simulated lung models that calculation of effective tidal volume would give similar readings to tidal volume measured at the airway, even in small patients. Future studies of tidal volume measurement accuracy in mechanically ventilated children should control for the degree of ETT leakage.

Adult↗

PubMed1994

Increased and more consistent tidal volumes during synchronized intermittent mandatory ventilation in newborn infants.

We compared expiratory tidal and minute ventilation during conventional and synchronized intermittent mandatory ventilation (IMV and SIMV) in 30 infants with respiratory failure. Identical ventilator settings were used during each mode in each infant. Tidal volumes of ventilator breaths were smaller during IMV than during SIMV (6.2 +/- 1.8 versus 7.4 +/- 1.9 ml/kg; p < 0.01). The coefficient of variation of tidal volumes was higher during IMV than SIMV for both ventilator (25 +/- 12% versus 15 +/- 8%) and spontaneous breaths (39 +/- 15% versus 24 +/- 10%, p < 0.001). Minute ventilation, however, was the same during both modes. During IMV, one infant breathed synchronously and two were phase-locked in asynchrony with the ventilator. The infants with a mixed interaction on IMV (27 of 30) had tidal volumes that depended on the phase of spontaneous breathing at the time of onset of each ventilator breath. Tidal volumes of IMV breaths that began during the first half of spontaneous expiration had the smallest tidal volumes (5.4 +/- 1.8 ml/kg, p < 0.01), followed by those that began during the last half of inspiration (6.4 +/- 1.8 ml/kg, p < 0.01). Thus, the synchrony produced by SIMV allowed the ventilator to deliver larger and more consistent tidal volumes than during IMV.

Humans↗

PubMed2000

Influence of tidal volume and thoraco-abdominal separation on the respiratory induced variation of the photoplethysmogram.

OBJECTIVE: The present study was aimed at determining the relative influences of tidal volume and thoraco-abdominal separation (relative thoracic and abdominal contribution to the tidal volume) on the respiratory induced intensity variation (RIIV) of the photoplethysmographic signal. The effects were studied in two body positions. METHODS: Respiratory inductive plethysmography was used for quantifying thoraco-abdominal separation and for assessing tidal volumes. 10 subjects were trained to perform widely varying degrees of thoraco-abdominal separation at different tidal volumes. The relationship between the RIIV signal peak-to-peak value (measured at the forearm), and the tidal volume and thoraco-abdominal separation was investigated in two body positions with the use of multiple linear regression. RESULTS: Larger tidal volume and more thoracic contribution to respiration were found to increase the RIIV peak-to-peak value (p < 0.0005). In the supine position, the tidal volume influence was stronger than that of thoraco-abdominal separation, and in the sitting position, the opposite was seen. CONCLUSIONS: The effects on the RIIV signal following changes in thoraco-abdominal separation and tidal volume are of the same order of magnitude. In the supine position, the influence of thoracic versus abdominal contribution to the tidal volume is not as significant as in the sitting position. Photoplethysmography is a promising technique for combined monitoring of several respiratory parameters, including tidal volume. In situations where the relative thoracic and abdominal contributions are likely to vary, the tidal volume information becomes less reliable.

Abdomen↗

PubMed2006

Reliability of respiratory tidal volume estimation by means of ambulatory inductive plethysmography.

Ambulatory monitoring of ventilatory parameters in everyday life, field research and clinical situations may offer new insights into respiratory functioning in health and disease. Recent technological advances that employ ambulatory inductive plethysmography could make monitoring of respiration outside the clinic and laboratory feasible. Inductive plethysmography provides a method for nonintrusive assessment of both timing (e.g. respiration rate) and volumetric parameters (e.g. tidal volume and minute ventilation), by which tidal volume is initially calibrated to direct measures of volume. Estimates of tidal volume assessed by this technique have been validated in laboratory investigations, usually examining within-individual relations to direct measures over a large range of tidal volume variation. However, the reliability of individual differences in tidal volume or other breathing parameters has not been tested under naturalistic measurement conditions using inductive plethysmography. We examined the test-retest reliability of respiration rate, tidal volume and other volumetric parameters of breathing over a period of six weeks of repeated measurements during baseline conditions and breathing exercises with 16 healthy freely moving volunteers in a Yoga course. Reliability of measurement was evaluated by calculating the average week-to-week between-subject correlation coefficients for each physiological measure. Additionally because body-mass index has been previously positively correlated to tidal volume, we also assessed this relationship as an external criterion of validity of tidal volume estimation. Regarding the latter, similar correlations to those previous studies were found (r = 0.6). Furthermore, reliability estimates were high and consistent across respiratory measures (typically r's = 0.7-0.8). These results suggest the validity of ambulatory inductive plethysmographic measurement of respiration, at least under relatively sedentary conditions. Findings also point to the stability of individual differences in respiratory parameters over consecutive weeks.

Activities of Daily Living↗

PubMed2006

Linear model and algorithm to automatically estimate the pressure limit of pressure controlled ventilation for delivering a target tidal volume.

OBJECTIVE: To theoretically assess the viability of an automatic procedure to support the anesthesiologist in properly setting mechanical ventilators when the operating conditions are switched from volume controlled to pressure controlled ventilation whilst maintaining the preset tidal volume. The procedure is based on a simple linear model of the ventilator breathing system with constant parameters and utilizes the signals gathered by the ventilator without the need to add further equipment. After a short period of stable volume controlled ventilation with the desired tidal volume, the herewith described algorithm allows the calculation of the value of pressure limit to set in pressure controlled mode which assures the previously settled tidal volume with the same breathing frequency and inspiratory-expiratory time ratio. METHODS: The algorithm allows the online identification of the four parameters necessary for the mathematical model that are obtained by means of a direct comparison between the pressure, flow and volume waveforms generated by the model and the analog signals provided by the ventilator. The theoretical approach was validated by two different ventilators, various settings, two breathing circuits, endotracheal tubes of various sizes and two mechanical simulators of the respiratory system operating in various conditions. RESULTS: Errors usually less than 5% (p < 0.05) on the target tidal volume were obtained for various settings typically used for adult ventilation in less than 10 s. The theoretical approach shows its limitations (errors of 10+/- 5%, p < 0.05) at high breathing frequencies (30-40 bpm) and low tidal volumes (200-300 ml). CONCLUSIONS: The proposed theoretical approach shows the viability, for adult settings, of one of the simplest mathematical model for mechanical ventilation in order to quickly and safely switch from volume controlled to pressure controlled ventilation. The algorithm could easily be in perspective implemented in the software of the ventilator providing the anesthesiologist with an indication on the value of pressure limit to set in order to safely switch ventilation mode.

Algorithms↗

PubMed2004

Arterial blood gases with 700 ml tidal volumes during out-of-hospital CPR.

The optimal tidal and minute ventilation during cardiopulmonary resuscitation (CPR) is not known. In the present study seven adult, non-traumatic, out-of-hospital cardiac arrest patients were intubated and mechanically ventilated at 12 min(-1) with 100% oxygen and a tidal volume of 700 ml (10 +/- 2 ml kg(-1)). Arterial blood gas samples were analysed after 6-8 min of unsuccessful resuscitation and mechanical ventilation. Mean PaCO2 was 5.2 +/- 1.3 kPa and mean PaO2 30.7 +/- 17.2 kPa. The patient with the highest (14 ml kg(-1)) and lowest (8 ml kg(-1)) tidal volumes per kg had the lowest and highest PaCO2 values of 2.6 and 6.8 kPa, respectively. Linear regression analysis confirmed a significant correlation between arterial pCO2 and tidal volume in ml/kg, r2 = 0.87. We conclude that aiming for an estimated ventilation of 10 ml kg(-1) tidal volume at frequency of 12 min(-1) might be expected to achieve normocapnia during ALS.

Aged↗

PubMed2005

[Exhaled tidal volume is overestimated due to cardiogenic oscillation: effects of ventilator and mode].

BACKGROUND: We investigated effects of cardiogenic oscillation on overestimation of tidal volume using a lung model, with three ventilators and two ventilatory modes. METHODS: We simulated cardiogenic oscillation at a rate of 90 breaths x min(-1) by ventilating one bellow of a two-bellow-type lung model. The magnitude of cardiogenic oscillation was defined as peak expiratory flow fluctuation when the airway was opened to the atmosphere. The lung model was mechanically ventilated with three ventilators (Bird 8400 STi, Servo-300, and Nellcor Puritan-Bennett 840), two ventilatory modes (volume- and pressure-controlled ventilation), and two respiratory rates (5 and 10 breaths x min(-1)) in random order. We recorded tidal volume on a ventilator monitor and calculated the discrepancy from the set tidal volume. RESULTS: With Bird 8400 STi, monitored tidal volume exceeded set tidal volume, regardless of volume- or pressure-controlled ventilation. The overestimation in tidal volume was larger with smaller respiratory rate and with larger cardiogenic oscillation. In contrast, with the other ventilators, the discrepancy was small. CONCLUSIONS: Exhaled tidal volume is overestimated during mechanical ventilation when cardiogenic oscillation is large.

Models, Biological↗

PubMed2000

Optimisation of tidal volumes given with self-inflatable bags without additional oxygen.

The European Resuscitation Council has recommended smaller tidal volumes of 500 ml during basic life support ventilation in order to minimise gastric inflation. One method of delivering these tidal volumes may be to use paediatric instead of adult self-inflatable bags; however, we have demonstrated in other studies that only 350 ml may be delivered, using this technique. The reduced risk of gastric inflation was offset by oxygenation problems, rendering the strategy of attempting to deliver tidal volumes of 500 ml with a paediatric self-inflatable bag questionable, at least when using room-air. In this report, we assessed the effects of a self-inflatable bag with a size between the maximum size of a paediatric (700 ml) and an adult (1500 ml) self-inflatable bag on respiratory variables and blood gases during bag-valve-mask ventilation. After induction of anaesthesia, 50 patients were block-randomised into two groups of 25 each. They were ventilated with room-air with either an adult (maximum volume, 1500 ml) or a newly developed medium-size (maximum volume, 1100 ml; Dräger, Lübeck, Germany) self-inflatable bag for 5 min before intubation. When compared with the adult self-inflatable bag, the medium-size bag resulted in significantly lower exhaled tidal volumes and tidal volumes per kg bodyweight (624 + 24 versus 738 +/- 20 ml, and 8.5 +/- 0.3 versus 10.7 +/- 0.3 ml kg(-1), respectively; P < 0.001), oxygen saturation (95 +/- 0.4 versus 96 +/- 0.3%; P < 0.05), and partial pressure of oxygen (78 +/- 3 versus 87 +/- 3 mmHg; P < 0.05). Carbon dioxide levels were comparable (37 +/- 1 versus 37 +/- 1 mmHg). Our results indicate that smaller tidal volumes of about 8 ml x kg(-1) (approximately 600 ml), given with a new medium-size self-inflatable bag and room-air, maintained adequate carbon dioxide elimination and oxygenation during bag-valve-mask ventilation. Accordingly, the new medium-size self-inflatable bag may combine both adequate ventilatory support and reduced risk of gastric inflation during bag-valve-mask ventilation.

Adult↗

PubMed1998

Relationship between inspiratory pressure and tidal volume in the anesthetized canine.

Hounds undergoing prolonged or complicated surgical procedures are often underventilated, as indicated by blood gas and end-tidal CO2 (CO2) values when using published ventilatory guidelines. We investigated the relationship between body weight, tidal volume, and inspiratory pressure delivered by the ventilator (lung inflation pressure) in 59 anesthetized hounds (19 to 33 kg). Animals were ventilated under positive pressure control and noninvasively instrumented to monitor blood pressure, ECG, oxygen saturation, CO2, and tidal volume. Weight, sex, and thorax measurements were recorded. All dogs were monitored at lung inflation pressures of 10, 14, and 18 cm H2O, with measurements recorded once CO2 stabilized. Veterinary guidelines recommend tidal volumes of 10 to 15 ml/kg of body weight and lung inflation pressures of 15 to 25 cm H2O. When inflation pressure was below guidelines (10), tidal volume was "normal" (10 to 15 ml/kg), but the animals were underventilated. When inflation pressure was "normal" (14 or 18 cm H2O), tidal volume was above guidelines. Physiologic variables were normal only when inflation pressure was 14 cm H2O. Weight and thorax depth accounted for 32 and 6%, respectively, of tidal volume variability, and tidal volume varied by +/- 250 ml at any given body weight and inflation pressure. None of the measured physical variables accurately predicted tidal volume. These data suggest that the inconsistency in tidal volume is due to a previously undescribed variability in respiratory compliance in the anesthetized hound and that the guidelines for ventilation during surgery need further investigation.

Anesthesia↗

PubMed1996

Indirect measurement of tidal volume by multi-lead electrocardiograms: effect of filtering, deep breath, lead and posture.

We examined a new method for estimating tidal volume from the electrocardiogram (ECG) in order to dispense with the need for sensors used exclusively for tidal volume measurement. The direction of the vector loop in the QRS complex (DVL) was defined as the direction of the diagonal line of the rectangle which circumscribed the vector loop obtained from two orthogonal leads. Two leads of the ECG were transformed into the orthogonal leads using Einthoven's triangle. The peak-to-peak change in the direction (the change in the DVL) was highly correlated with tidal volume. Low-pass filtering of the ECG produced a better correlation between tidal volume and the change in the DVL, when the cutoff frequency was set at 20-45 Hz. A tidal volume of less than 1.21 was correlated more highly with the change in the DVL than a tidal volume of more than 1.21 A combination of leads I and III produced the best correlation between tidal volume and the change in the DVL, compared with other combinations. The posture of the subject had some effects on the slope of the linear regression between tidal volume and the change in the DVL.

Electrocardiography↗

PubMed2000

Smaller tidal volumes with room-air are not sufficient to ensure adequate oxygenation during bag-valve-mask ventilation.

The European Resuscitation Council has recommended decreasing tidal volume during basic life support ventilation from 800 to 1200 ml, as recommended by the American Heart Association, to 500 ml in order to minimise stomach inflation. However, if oxygen is not available at the scene of an emergency, and small tidal volumes are given during basic life support ventilation with a paediatric self-inflatable bag and room-air (21% oxygen), insufficient oxygenation and/or inadequate ventilation may result. When apnoea occurred after induction of anaesthesia, 40 patients were randomly allocated to room-air ventilation with either an adult (maximum volume, 1500 ml) or paediatric (maximum volume, 700 ml) self-inflatable bag for 5 min before intubation. When using an adult (n=20) versus paediatric (n=20) self-inflatable bag, mean +/-SEM tidal volumes and tidal volumes per kilogram were significantly (P<0.0001) larger (719+/-22 vs. 455+/-23 ml and 10.5+/-0.4 vs. 6.2+/-0.4 ml kg(-1), respectively). Compared with an adult self-inflatable bag, bag-valve-mask ventilation with room-air using a paediatric self-inflatable bag resulted in significantly (P<0.01) lower paO(2) values (73+/-4 vs. 87+/-4 mmHg), but comparable carbon dioxide elimination (40+/-2 vs. 37+/-1 mmHg; NS). In conclusion, our results indicate that smaller tidal volumes of approximately 6 ml kg(-1) ( approximately 500 ml) given with a paediatric self-inflatable bag and room-air maintain adequate carbon dioxide elimination, but do not result in sufficient oxygenation during bag-valve-mask ventilation. Thus, if small (6 ml kg(-1)) tidal volumes are being used during bag-valve-mask ventilation, additional oxygen is necessary. Accordingly, when additional oxygen during bag-valve-mask ventilation is not available, only large tidal volumes of approximately 11 ml kg(-1) were able to maintain both sufficient oxygenation and carbon dioxide elimination.

Adult↗

PubMed1994

Tidal volume and alveolar clearance of insoluble particles.

We studied the effect of 3 h of large tidal volume ventilation on alveolar clearance of 0.63-micron fluorescent latex particles in rabbits during pentobarbital anesthesia. After particle deposition, six animals were killed as controls, six were subjected to large tidal volume ventilation with a peak pressure of 27 cmH2O, and six were subjected to conventional ventilation with a peak pressure of 11 cmH2O. Mean tidal volumes were 30.2 +/- 6.1 and 8.4 +/- 1.6 ml/kg in the large tidal volume and conventional groups, respectively. End-expiratory pressure was 2 cmH2O in all groups. Compliance decreased only after large tidal ventilation (P = 0.0036). Compared with controls the conventional ventilation group showed no alveolar clearance, but more particles were clustered within macrophages (P = 0.01). Compared with other groups the large tidal volume group had fewer alveolar particles (P = 0.0005), most of which were single particles. Accordingly, large tidal volumes enhance alveolar particle clearance, which is possibly related to distension-related evacuation of surfactant to proximal airways. Clearance may be due to accelerated motion of the particle-loaded macrophage in response to the fast film motion. Alternatively, single particles embedded in the surfactant film may be dragged by the fast-moving film toward the airways.

Animals↗