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BJA Advance Access originally published online on August 21, 2006
British Journal of Anaesthesia 2006 97(5):732-741; doi:10.1093/bja/ael214
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Sources of error in partial rebreathing pulmonary blood flow measurements in lungs with emphysema and pulmonary embolism{dagger}

J. S. Yem, M. J. Turner* and A. B. Baker

Department of Anaesthetics, The University of Sydney, Royal Prince Alfred Hospital Missenden Road, Camperdown, NSW 2050, Australia

*Corresponding author: Department of Anaesthetics, University of Sydney, Royal Prince Alfred Hospital, Building 89 Level 4, Missenden Road, Camperdown, NSW 2050, Australia. E-mail: mjturner{at}usyd.edu.au

Background. Studies of the accuracy of partial rebreathing measurements of pulmonary blood flow (PBF) in patients with abnormal lungs have not fully explained the sources of error.

Methods. We used computer models of emphysema and pulmonary embolism incorporating both ventilation-perfusion (Formula) and ventilation-volume (Formula) heterogeneity to investigate systematic errors in partial rebreathing PBF measurements. We studied (i) errors produced under usual conditions, (ii) effects of recirculation, (iii) effects of alveolar–proximal airway and alveolar-capillary PCO2 and Formula differences, (iv) effects of alveolar Formula inhomogeneity and (v) effects of rebreathing time.

Results. In the pulmonary embolism model the systematic error is only acceptable (<10%) when the simulated PBF is low (2–3 litre min–1). In the emphysema model PBF is underestimated by more than 20% at all cardiac outputs studied. Four sources of systematic errors were found. (i) Alveolar–proximal airway PCO2 gradients and flux differences between the proximal airway and alveolar compartments contribute most to the systematic error. (ii) Formula inhomogeneity causes PCO2 gradients between the alveolar compartments and pulmonary capillary blood, and between pulmonary capillary compartments. (iii) Rebreathing times are inadequate in the presence of Formula mismatch. (iv) The apparent effect of venous blood recirculation is small in emphysema but significant in pulmonary embolism.

Conclusions. We conclude that PBF cannot be measured accurately by partial rebreathing in lungs with emphysema or embolism. Systematic errors are caused mainly by errors in end-tidal PCO2 values.

{dagger}Conference presentations: Sources of error in non-invasive pulmonary blood flow measurements by partial rebreathing in lungs with emphysema or pulmonary embolism. XIII World Congress Of Anaesthesiologists, April 2004, Paris, France.


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J. S. Yem, M. J. Turner, A. B. Baker, I. H. Young, and A. B. H. Crawford
A tidally breathing model of ventilation, perfusion and volume in normal and diseased lungs
Br. J. Anaesth., November 1, 2006; 97(5): 718 - 731.
[Abstract] [Full Text] [PDF]


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