A correction for this article has been published in Critical Care 2009, 13:405

Research

Nitrogen washout/washin, helium dilution and computed tomography in the assessment of end expiratory lung volume

Davide Chiumello¹ , Massimo Cressoni² , Monica Chierichetti² , Federica Tallarini² , Marco Botticelli² , Virna Berto² , Cristina Mietto² and Luciano Gattinoni^1,2

¹  Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS – "Ospedale Maggiore Policlinico Mangiagalli Regina Elena", via Francesco Sforza 35, 20122, Milano, Italy

²  Istituto di Anestesiologia e Rianimazione, Fondazione IRCCS – "Ospedale Maggiore Policlinico Mangiagalli Regina Elena" di Milano, Italy; Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milano, Italy

author email corresponding author email

Critical Care 2008, 12:R150doi:10.1186/cc7139

Published:	1 December 2008

Abstract

Introduction

End expiratory lung volume (EELV) measurement in the clinical setting is routinely performed using the helium dilution technique. A ventilator that implements a simplified version of the nitrogen washout/washin technique is now available. We compared the EELV measured by spiral computed tomography (CT) taken as gold standard with the lung volume measured with the modified nitrogen washout/washin and with the helium dilution technique.

Methods

Patients admitted to the general intensive care unit of Ospedale Maggiore Policlinico Mangiagalli Regina Elena requiring ventilatory support and, for clinical reasons, thoracic CT scanning were enrolled in this study. We performed two EELV measurements with the modified nitrogen washout/washin technique (increasing and decreasing inspired oxygen fraction (FiO₂) by 10%), one EELV measurement with the helium dilution technique and a CT scan. All measurements were taken at 5 cmH₂O airway pressure. Each CT scan slice was manually delineated and gas volume was computed with custom-made software.

Results

Thirty patients were enrolled (age = 66 +/- 10 years, body mass index = 26 +/- 18 Kg/m², male/female ratio = 21/9, partial arterial pressure of carbon dioxide (PaO₂)/FiO₂ = 190 +/- 71). The EELV measured with the modified nitrogen washout/washin technique showed a very good correlation (r² = 0.89) with the data computed from the CT with a bias of 94 +/- 143 ml (15 +/- 18%, p = 0.001), within the limits of accuracy declared by the manufacturer (20%). The bias was shown to be highly reproducible, either decreasing or increasing the FiO₂ being 117+/-170 and 70+/-160 ml (p = 0.27), respectively. The EELV measured with the helium dilution method showed a good correlation with the CT scan data (r² = 0.91) with a negative bias of 136 +/- 133 ml, and appeared to be more correct at low lung volumes.

Conclusions

The EELV measurement with the helium dilution technique (at low volumes) and modified nitrogen washout/washin technique (at all lung volumes) correlates well with CT scanning and may be easily used in clinical practice.

Trial Registration

Current Controlled Trials NCT00405002.