Calibration of Fleisch and screen pneumotachographs for use with various oxygen concentrations

Indirect Calorimetry in Spontaneously Breathing, Mechanically Ventilated and Extracorporeally Oxygenated Patients: An Engineering Review

Indirect calorimetry (IC) is considered the gold standard for measuring resting energy expenditure (REE). This review presents an overview of the different techniques to assess REE with special regard to the use of IC in critically ill patients on extracorporeal membrane oxygenation (ECMO), as well as to the sensors used in commercially available indirect calorimeters. The theoretical and technical aspects of IC in spontaneously breathing subjects and critically ill patients on mechanical ventilation and/or ECMO are covered and a critical review and comparison of the different techniques and sensors is provided. This review also aims to accurately present the physical quantities and mathematical concepts regarding IC to reduce errors and promote consistency in further research. By studying IC on ECMO from an engineering point of view rather than a medical point of view, new problem definitions come into play to further advance these techniques.

In-airway molecular flow sensing: A new technology for continuous, noninvasive monitoring of oxygen consumption in critical care

There are no satisfactory methods for monitoring oxygen consumption in critical care. To address this, we adapted laser absorption spectroscopy to provide measurements of O2, CO2, and water vapor within the airway every 10 ms. The analyzer is integrated within a novel respiratory flow meter that is an order of magnitude more precise than other flow meters. Such precision, coupled with the accurate alignment of gas concentrations with respiratory flow, makes possible the determination of O2 consumption by direct integration over time of the product of O2 concentration and flow. The precision is illustrated by integrating the balance gas (N2 plus Ar) flow and showing that this exchange was near zero. Measured O2 consumption changed by <5% between air and O2 breathing. Clinical capability was illustrated by recording O2 consumption during an aortic aneurysm repair. This device now makes easy, accurate, and noninvasive measurement of O2 consumption for intubated patients in critical care possible.

Flow measurement in mechanical ventilation: a review

Accurate monitoring of flow rate and volume exchanges is essential to minimize ventilator-induced lung injury. Mechanical ventilators employ flowmeters to estimate the amount of gases delivered to patients and use the flow signal as a feedback to adjust the desired amount of gas to be delivered. Since flowmeters play a crucial role in this field, they are required to fulfill strict criteria in terms of dynamic and static characteristics. Therefore, mechanical ventilators are equipped with only the following kinds of flowmeters: linear pneumotachographs, fixed and variable orifice meters, hot wire anemometers, and ultrasonic flowmeters. This paper provides an overview of these sensors. Their working principles are described together with their relevant advantages and disadvantages. Furthermore, the most promising emerging approaches for flowmeters design (i.e., fiber optic technology and three dimensional micro-fabrication) are briefly reviewed showing their potential for this application.

Influence of gas temperature on the performances of a low dead space capillary type pneumotachograph for neonatal ventilation

The design and calibration of a pneumotachograph with capillary type resistance is here described. The pneumotacograph has been designed aimed to the measurement of flow rate in the neonatal ventilation range (+/-10 L/min) and is characterized by a low dead space (2mL). The calibration curve is quadratic and coefficient values for Rohrer equation have been obtained by fitting experimental data (R(2)=0.99, MSE=1Pa(2)). Sensitivity varies from about 25 PaL(-1)min for flow rates lower than 4 L/min to about 58 PaL(-1)min for flow rates higher than 7 L/min. The influence of airflow temperature on Rohrer equation coefficients has then been analyzed. A gas temperature variation in the range 19-37 degrees C corresponds to a 10% average output percent variation, being the discrepancy higher at higher flow rates. A linear dependence of Rohrer equation second order term coefficient from temperature has been hypothesized. By fitting experimental data with the proposed equation MSE decreases from 1Pa(2) to 0.3Pa(2) thus, increasing repeatability (<2%) in the overall flow rate and temperature range considered. The second order term coefficient in Rohrer equation increases with temperature of about 0.6%/ degrees C. Rohrer equation, corrected for gas temperature, allows then to increase the repeatability of the here proposed capillary type pneumotacograph, while maintaining a good sensitivity with low dead space.

Calibration of pneumotachographs using a calibrated syringe

Pneumotachograph require frequent calibration. Constant-flow methods allow polynomial calibration curves to be derived but are time consuming. The iterative syringe stroke technique is moderately efficient but results in discontinuous conductance arrays. This study investigated the derivation of first-, second-, and third-order polynomial calibration curves from 6 to 50 strokes of a calibration syringe. We used multiple linear regression to derive first-, second-, and third-order polynomial coefficients from two sets of 6-50 syringe strokes. In part A, peak flows did not exceed the specified linear range of the pneumotachograph, whereas flows in part B peaked at 160% of the maximum linear range. Conductance arrays were derived from the same data sets by using a published algorithm. Volume errors of the calibration strokes and of separate sets of 70 validation strokes (part A) and 140 validation strokes (part B) were calculated by using the polynomials and conductance arrays. Second- and third-order polynomials derived from 10 calibration strokes achieved volume variability equal to or better than conductance arrays derived from 50 strokes. We found that evaluation of conductance arrays using the calibration syringe strokes yields falsely low volume variances. We conclude that accurate polynomial curves can be derived from as few as 10 syringe strokes, and the new polynomial calibration method is substantially more time efficient than previously published conductance methods.

Viscosity and density of common anaesthetic gases: implications for flow measurements

Although viscosity (mu) is a crucial factor in measurements of flow with a pneumotachograph, and density (rho) also plays a role in the presence of turbulent flow, these material constants are not available for the volatile anaesthetic agents commonly administered in clinical practice. Thus, we determined experimentally mu and rho of pure volatile anaesthetic agents. Input impedance of a rigid-wall polyethylene tube (Zt) was measured when the tube was filled with various mixtures of carrier gases (air, 100% oxygen, 50% oxygen+50% nitrogen) to which different concentrations of volatile anaesthetic inhalation agents (halothane, isoflurane, sevoflurane, and desflurane) had been added. Mu and rho were calculated from real and imaginary portions of Zt, respectively, using the appropriate physical equations. Multiple linear regression was applied to estimate mu and rho of pure volatile agents. Viscosity values of pure volatile agents were markedly lower than those for oxygen or nitrogen. Clinically applied concentrations, however, did not markedly affect the viscosity of the gas mixture (maximum of 3.5% decrease in mu for 2 MAC desflurane). In contrast, all of the volatile agents significantly affected rho even at routinely used concentrations. Our results suggest that the composition of the carrier gas has a greater impact on viscosity than the amount and nature of the volatile anaesthetic agent whereas density is more influenced by volatile agent concentrations. Thus, the need for a correction factor in flow measurements with a pneumotachograph depends far more on the carrier gas than the concentration of volatile agent administered, although the latter may play a role in particular experimental or clinical settings.

Accuracy of volume measurements in mechanically ventilated newborns: a comparative study of commercial devices

OBJECTIVE

Ventilatory measurements in ventilated newborns are increasingly used to monitor and to optimize mechanical ventilation. The aim of this study was to compare the accuracy of volume measurements by different instruments using standardized laboratory conditions.

METHODS

The accuracy of displayed volume values of different commercial devices (Bicore CP-100, Ventrak 1500, Ventrak 1550, Babylog 8000, PEDS IV and SensorMedics 2600) was investigated using adjustable calibration syringes (volume range 2-60 ml, breathing rates 30/min-60/min) and humidified (>95%), heated (35 degrees C) breathing gas with adjustable FIO2 (0.21-1.0). The pneumotach and also the tubes were placed within an incubator (37 degrees C).

RESULTS

The relative volume error of all devices was in conformity with clinically allowed tolerances (Bicore CP-100 6.4+/-0.5% (mean +/- SD), Ventrak 1500 3.6+/-4.2%, Ventrak 1550 6.5+/-2.7%, Babylog 8000 -5.5+/-1.5%, PEDS IV -4.0+/-1.4%, SensorMedics 2600 3.5+/-1.75%) for the measuring range studied (10 ml < V < 60 ml, rate 30-60/min, FIO2 = 0.21). Unacceptable errors were obtained for volumes lower than 10 ml with Bicore CP-100 (-28.5+/-26%) and PEDS IV (-10.3+/-3.4%). Changes in FIO2 had an important influence on volume measurements and only the SensorMedics 2600 and the PEDS IV corrected properly for FIO2 changes.

CONCLUSION

Most of the currently available neonatal spirometry devices allow sufficiently accurate volume measurements in the range of 10-60 ml and at frequencies between 30-60/min provided that an increased FIO2 is taken into account.

Design and calibration of unicapillary pneumotachographs

This study presents a method for design and calibration of unicapillary pneumotachographs for small-animal experiments. The design, based on Poiseuille's law, defines a set of internal radius and length values that allows for laminar flow, measurable pressure differences, and minimal interference with animal's respiratory mechanics and gas exchange. A third-order polynomial calibration (Pol) of the pressure-flow relationship was employed and compared with linear calibration (Lin). Tests were done for conditions of ambient pressure (Pam) and positive pressure (Ppos) ventilation at different flow ranges. A physical model designed to match normal and low compliance in rats was used. At normal compliance, Pol provided lower errors than Lin for mixed (1-12 ml/s), mean (4-10 ml/s), and high (8-12 ml/s) flow rate calibrations for both Pam and Ppos inspiratory tests (P < 0.001 for all conditions) and expiratory tests (P < 0.001 for all conditions). At low compliance, they differed significantly with 8.6 +/- 4.1% underestimation when Lin at Pam was used in Ppos tests. Ppos calibration, preferably in combination with Pol, should be used in this case to minimize errors (Pol = 0.8 +/- 0.5%, Lin = 6.5 +/- 4.0%, P < 0.0005). Nonlinear calibration may be useful for improvement of flow and volume measurements in small animals during both Pam and Ppos ventilation.

System to obtain exercise respiratory flow waveforms

A system for obtaining respiratory flow rate waveforms, tidal volume, minute volume, respiration rate, inhalation time and exhalation time is described. The system is based on a microcomputer with analog-to-digital converter board. System software allows calibration, data acquisition and data analysis. Data can be obtained automatically at fixed time intervals. The system is inexpensive and reliable.

Measurement of respiratory mechanics in a mechanically ventilated infant lung simulator: effects of variations in the frequency response of the flow measurement system

The frequency responses of systems used to measure flow and pressure in ventilated infants may differ, and hence affect estimates of resistance and compliance. We estimated resistance and compliance in 16 ventilated mechanical lung models using linear regression while varying the frequency response of the flow measurement system. Lung models comprised combinations of four sections of tubing and four bottles filled with steel wool. The cut-off frequencies of a filter in the flow measurement system were chosen to yield time delays of 0, +/-3, +/-6, and +/-9 ms relative to the pressure signal. When the phase lags in the measurement systems were not equal at 10 Hz, a bias in resistance approximately (relative delay) x (elastance) ensued. The bias in the resistance estimate when resistance is 5 Pa ml-1 s and compliance is 2 ml kPa-1 is approximately 28% per ms of delay mismatch. Time-shifting the flow data to eliminate the phase discrepancy reduced the resistance bias by 85%. The residual resistance bias was assumed to be due to inappropriate amplitude response. Compliance measurements were affected by less than 8% and less than 2% after time correction of the flow data. Pressure and flow signals must be synchronized to within 1 ms at 10 Hz and the amplitude responses of the measurement systems must be adequate for reliable resistance measurement.

Bandwidths of respiratory gas flow and pressure waveforms in mechanically ventilated infants

The frequency content of airway pressure and gas flow in mechanically ventilated infants (MVIS) has not been adequately investigated. Pressure-cycled infant ventilators generate pressure pulses with short rise-times. Gas flow is approximately equal to the derivative of pressure when lung compliance is low, and hence contains high-frequency components. We defined bandwidth as that frequency fm below which 99.9% of the energy of the signal resided. Simulation of the measurement process using measurement systems with frequency response similar to sixth-order Bessel filters and a lung model comprising series resistance, inertance and compliance showed that measurement systems with frequency response flat +/- 10% to fm yield time domain errors less than 3% of the peak value. We digitized pressure and flow signals from 10-20 ventilator (Healthdyne 105) breaths in 33 stable MVIS. The transducers' (Gould P50, Hans Rudolph 8300 screen pneumotach) frequency responses had been measured between 1 Hz and 100 Hz and phase matched at 10 Hz. We calculated total respiratory resistance R and elastance E using multiple linear regression, and ensemble-average power spectral density using the FFT with a rectangular time window and padding to 2048 points. Power spectra were compensated for non-unity transducer and anti-alias filter responses up to 60 Hz. Measured data sequences that were not self-windowing due to spontaneous breathing efforts, that yielded regression R2 < 0.95 or that contained flow oscillations due to secretions in the airway were discarded. Satisfactory results were obtained from more than eight breaths in 18 infants. Mean bandwidths (+/- SD) of pressure and flow waveforms were 4.7 +/- 0.7, range 3.5-5.9 and 19.6 +/- 6.5, range 10.8-32.1 Hz, respectively. Flow bandwidths B correlated with the respiratory time constant tau (B = -77.2 tau + 26.8, R2 = 0.55, P < 0.0002), and with elastance E (B = 61.4E + 10.1, R2 = 0.74, P < 0.0001). We conclude that the bandwidth of the flow waveform increases with decreasing compliance and mechanical time constant. The frequency response of pressure and flow measurement systems should be flat +/- 10% at least up to 6 and 32 Hz respectively to obtain data with dynamic errors less than 3% in infants with low-compliance lung disease.