Automated sulfur hexafluoride washout functional residual capacity measurement system for any mode of mechanical ventilation as well as spontaneous respiration

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Abstract
A new sulfur hexafluoride (SF6) washout functional residual capacity (FRC) measurement system has been developed which will work with any mode of mechanical ventilation, as well as with spontaneous respiration. This system was evaluated in three different human studies. In the first two studies, the accuracy of the system was compared with He dilution and body plethysmography in 12 spontaneously breathing normal volunteers and in 12 spontaneously breathing chronic obstructive pulmonary disease (COPD) patients. In the third study, the reproducibility and efficacy of using the system in the ICU was tested in 12 adult respiratory distress syndrome (ARDS) patients who were mechanically ventilated with PEEP. In the normal volunteers, there was no significant difference between the three measurement techniques. In the COPD group, there was an overall significant difference between measurement techniques (F(2,28] = 17.18, p < .0001) and the rank of the magnitude of the FRC measurements from lowest to highest was SF6 washout, He dilution, and body plethysmography. There was a significant difference in accuracy between the COPD and normal volunteer groups (F[2,28] = 12.24, p < .0002). There were a total of 1,227 FRC measurements made on the 12 ARDS patients. The number of FRC measurements per patients was 102 .+-. 13 (SEM). The "stable" periods were 14 .+-. 2 h long and ranged from 60 min to 63.5 h. The reproducibility for all 12 patients was 188 .+-. 17 ml or 11.7 .+-. 0.7%. This automated SF6 washout system should make routine FRC measurements in patients who are being mechanically ventilated simple and easy to do. The system does not require extensive modification of the breathing circuit or interruption of ventilatory support.