Physiologic Factors Influencing the Arterial-To-End-Tidal CO2 Difference and the Alveolar Dead Space Fraction in Spontaneously Breathing Anesthetised Horses.
Abstract: The arterial to end-tidal CO difference (PCO) and alveolar dead space fraction (VDalv = PCO/PaCO), are used to estimate Enghoff's "pulmonary dead space" (V/Q), a factor which is also influenced by venous admixture and other pulmonary perfusion abnormalities and thus is not just a measure of dead space as the name suggests. The aim of this experimental study was to evaluate which factors influence these CO indices in anesthetized spontaneously breathing horses. Six healthy adult horses were anesthetized in dorsal recumbency breathing spontaneously for 3 h. Data to calculate the CO indices (response variables) and dead space variables were measured every 30 min. Bohr's physiological and alveolar dead space variables, cardiac output (CO), mean pulmonary pressure (MPP), venous admixture [Formula: see text], airway dead space, tidal volume, oxygen consumption, and slope III of the volumetric capnogram were evaluated (explanatory variables). Univariate Pearson correlation was first explored for both CO indices before V/Q and the explanatory variables with rho were reported. Multiple linear regression analysis was performed on PCO and VDalv assessing which explanatory variables best explained the variance in each response. The simplest, best-fit model was selected based on the maximum adjusted and smallest Mallow's p (C). The of the selected model, representing how much of the variance in the response could be explained by the selected variables, was reported. The highest correlation was found with the alveolar part of V/Q to alveolar tidal volume ratio for both, PCO ( = 0.899) and VDalv ( = 0.938). Venous admixture and CO best explained PCO ( = 0.752; C = 4.372) and VDalv ( = 0.711; C = 9.915). Adding MPP (PCO) and airway dead space (VDalv) to the models improved them only marginally. No "real" dead space variables from Bohr's equation contributed to the explanation of the variance of the two CO indices. PCO and VDalv were closely associated with the alveolar part of V/Q and as such, were also influenced by variables representing a dysfunctional pulmonary perfusion. Neither PCO nor VDalv should be considered pulmonary dead space, but used as global indices of V/Q mismatching under the described conditions.
Publication Date: 2018-03-28 PubMed ID: 29644221PubMed Central: PMC5882784DOI: 10.3389/fvets.2018.00058Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Journal Article
Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
This research article focuses on the factors that affect the arterial to end-tidal CO2 difference (PCO) and the alveolar dead space fraction (VDalv) in anesthetized, spontaneously breathing horses. This research is significant as these factors are widely used to estimate Enghoff’s “pulmonary dead space” (V/Q).
Study Design and Methodology
- The authors conducted an experimental study on six healthy adult horses. These horses were anesthetized in a dorsal recumbency position and left to breathe spontaneously for three hours.
- Measurements for calculating both CO2 indices and dead space variables were taken every 30 minutes.
- The explanatory variables evaluated included Bohr’s physiological and alveolar dead space variables, cardiac output (CO), mean pulmonary pressure (MPP), venous admixture, airway dead space, tidal volume, oxygen consumption, and slope III of the volumetric capnogram.
- Data analysis included univariate Pearson correlation for both CO2 indices and multiple linear regression analysis assessing which explanatory variables explained the variation in each response.
Key Findings
- The highest correlation was found with the alveolar part of V/Q to the alveolar tidal volume ratio, for both PCO and VDalv.
- Venous admixture and cardiac output best explained PCO, while VDalv was best explained by the same two variables.
- Adding mean pulmonary pressure to the PCO model and airway dead space to the VDalv model only marginally improved the models.
- None of the real dead space variables from Bohr’s equation contributed to the explanation of the variance of the two CO2 indices.
- PCO and VDalv were closely associated with the alveolar part of V/Q. As such, they are also influenced by variables representing a dysfunctional pulmonary perfusion.
Conclusion
- Based on the study’s results, neither PCO nor VDalv should be considered as pulmonary dead space. Rather, they should be used as global indices of V/Q mismatching under the conditions described in the study.
Cite This Article
APA
Mosing M, Böhm SH, Rasis A, Hoosgood G, Auer U, Tusman G, Bettschart-Wolfensberger R, Schramel JP.
(2018).
Physiologic Factors Influencing the Arterial-To-End-Tidal CO2 Difference and the Alveolar Dead Space Fraction in Spontaneously Breathing Anesthetised Horses.
Front Vet Sci, 5, 58.
https://doi.org/10.3389/fvets.2018.00058 Publication
Researcher Affiliations
- College of Veterinary Medicine, Murdoch University, Perth, WA, Australia.
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany.
- College of Veterinary Medicine, Murdoch University, Perth, WA, Australia.
- College of Veterinary Medicine, Murdoch University, Perth, WA, Australia.
- Anaesthesiology and Perioperative Intensive Care Medicine, Veterinary University Vienna, Vienna, Austria.
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina.
- Division of Anaesthesiology, Vetsuisse Faculty, Zurich, Switzerland.
- Anaesthesiology and Perioperative Intensive Care Medicine, Veterinary University Vienna, Vienna, Austria.
References
This article includes 41 references
- Nyman G, Funkquist B, Kvart C, Frostell C, Tokics L, Strandberg A, Lundquist H, Lundh B, Brismar B, Hedenstierna G. Atelectasis causes gas exchange impairment in the anaesthetised horse.. Equine Vet J 1990 Sep;22(5):317-24.
- Briganti A, Portela DA, Grasso S, Sgorbini M, Tayari H, Bassini JR, Vitale V, Romano MS, Crovace A, Breghi G, Staffieri F. Accuracy of different oxygenation indices in estimating intrapulmonary shunting at increasing infusion rates of dobutamine in horses under general anaesthesia.. Vet J 2015 Jun;204(3):351-6.
- NUNN JF, HILL DW. Respiratory dead space and arterial to end-tidal carbon dioxide tension difference in anesthetized man.. J Appl Physiol 1960 May;15:383-9.
- SEVERINGHAUS JW, STUPFEL MA, BRADLEY AF. Alveolar dead space and arterial to end-tidal carbon dioxide differences during hypothermia in dog and man.. J Appl Physiol 1957 May;10(3):349-55.
- Mitchell B, Littlejohn A. Influence of anaesthesia and posture on arterial oxygen and carbon dioxide tensions, alveaolr dead space and pulse rate in the horse. Vet Anaesth Analg (1972) 3(1):61–74.
- Moens Y. Arterial-alveolar carbon dioxide tension difference and alveolar dead space in halothane anaesthetised horses.. Equine Vet J 1989 Jul;21(4):282-4.
- McDonell WN, Kerr C. Physiology, pathophysiology, and anesthetic management of patients with respiratory disease. Veterinary Anesthesia and Analgesia 5th ed In: Grimm KA, Lamont LA, Tranquilli WJ, Greene SA, Robertson SA, editors. Iowa, US: Wiley Blackwell; (2015). p. 513–55.
- Bohr C. Über die Lungenathmung. Centralblatt für Physiologie (1887) 1(14):236–68.
- Enghoff H. Volumen inefficax. Bemerkungen zur Frage des schädlichen Raumes. Uppsala Lak Forhandl (1938) 44:191–218.
- Tusman G, Sipmann FS, Bohm SH. Rationale of dead space measurement by volumetric capnography.. Anesth Analg 2012 Apr;114(4):866-74.
- Wagner PD. Causes of a high physiological dead space in critically ill patients.. Crit Care 2008;12(3):148.
- Suarez-Sipmann F, Santos A, Böhm SH, Borges JB, Hedenstierna G, Tusman G. Corrections of Enghoff's dead space formula for shunt effects still overestimate Bohr's dead space.. Respir Physiol Neurobiol 2013 Oct 1;189(1):99-105.
- Verscheure S, Massion PB, Verschuren F, Damas P, Magder S. Volumetric capnography: lessons from the past and current clinical applications.. Crit Care 2016 Jun 23;20(1):184.
- Breen PH, Mazumdar B, Skinner SC. Comparison of end-tidal PCO2 and average alveolar expired PCO2 during positive end-expiratory pressure.. Anesth Analg 1996 Feb;82(2):368-73.
- Hardman JG, Aitkenhead AR. Estimation of alveolar deadspace fraction using arterial and end-tidal CO2: a factor analysis using a physiological simulation.. Anaesth Intensive Care 1999 Oct;27(5):452-8.
- Suarez-Sipmann F, Bohm SH, Tusman G. Volumetric capnography: the time has come.. Curr Opin Crit Care 2014 Jun;20(3):333-9.
- Burrows FA. Physiologic dead space, venous admixture, and the arterial to end-tidal carbon dioxide difference in infants and children undergoing cardiac surgery.. Anesthesiology 1989 Feb;70(2):219-25.
- Strang CM, Hachenberg T, Fredén F, Hedenstierna G. Development of atelectasis and arterial to end-tidal PCO2-difference in a porcine model of pneumoperitoneum.. Br J Anaesth 2009 Aug;103(2):298-303.
- Tusman G, Suarez-Sipmann F, Böhm SH, Pech T, Reissmann H, Meschino G, Scandurra A, Hedenstierna G. Monitoring dead space during recruitment and PEEP titration in an experimental model.. Intensive Care Med 2006 Nov;32(11):1863-71.
- Douglas CG. A method for determining the total respiratory exchange in man. J Physiol (1911) 42:17–8.
- Fletcher R. Deadspace during anaesthesia.. Acta Anaesthesiol Scand Suppl 1990;94:46-50.
- Schramel JP, Wimmer K, Ambrisko TD, Moens YP. A novel flow partition device for spirometry during large animal anaesthesia.. Vet Anaesth Analg 2014 Mar;41(2):191-5.
- Mosing M, MacFarlane P, Bardell D, Lüthi L, Cripps PJ, Bettschart-Wolfensberger R. Continuous positive airway pressure (CPAP) decreases pulmonary shunt in anaesthetized horses.. Vet Anaesth Analg 2016 Nov;43(6):611-622.
- Kalchofner KS, Picek S, Ringer SK, Jackson M, Hässig M, Bettschart-Wolfensberger R. A study of cardiovascular function under controlled and spontaneous ventilation in isoflurane-medetomidine anaesthetized horses.. Vet Anaesth Analg 2009 Sep;36(5):426-35.
- Kobler A, Hartnack S, Sacks M, Bettschart-Wolfensberger R. Evaluation of tidal volume measurements of the anaesthesia device Tafonius® in vitro and in vivo. Pferdeheilkunde (2016) 32(5):449–56.
- Tusman G, Scandurra A, Böhm SH, Suarez-Sipmann F, Clara F. Model fitting of volumetric capnograms improves calculations of airway dead space and slope of phase III.. J Clin Monit Comput 2009 Aug;23(4):197-206.
- Lumb AB. Nunn’s Applied Respiratory Physiology. 7th ed Oxford, England: Elsevier; (2010).
- Blankman P, Shono A, Hermans BJ, Wesselius T, Hasan D, Gommers D. Detection of optimal PEEP for equal distribution of tidal volume by volumetric capnography and electrical impedance tomography during decreasing levels of PEEP in post cardiac-surgery patients.. Br J Anaesth 2016 Jun;116(6):862-9.
- Sacks M, Mosing M. Volumetric capnography to diagnose venous air embolism in an anaesthetised horse.. Vet Anaesth Analg 2017 Jan;44(1):189-190.
- Fletcher R, Jonson B, Cumming G, Brew J. The concept of deadspace with special reference to the single breath test for carbon dioxide.. Br J Anaesth 1981 Jan;53(1):77-88.
- Drummond GB, Fletcher R. Deadspace: invasive or not?. Br J Anaesth 2006 Jan;96(1):4-7.
- Kerr CL, McDonell WN. Oxygen supplementation and ventilatory support. Equine Anesthesia: Monitoring and Emergency Therapy In: Muir WW, Hubbell JAE, editors. St. Louis, Missouri, US: Saunders Elsevier; (2009). p. 332–52.
- Fletcher R. The relationship between the arterial to end-tidal PCO2 difference and hemoglobin saturation in patients with congenital heart disease.. Anesthesiology 1991 Aug;75(2):210-6.
- Benumof JL, Wahrenbrock EA. Blunted hypoxic pulmonary vasoconstriction by increased lung vascular pressures.. J Appl Physiol 1975 May;38(5):846-50.
- Tusman G, Sipmann FS, Borges JB, Hedenstierna G, Bohm SH. Validation of Bohr dead space measured by volumetric capnography.. Intensive Care Med 2011 May;37(5):870-4.
- Robinson NE. The respiratory system. Equine Anesthesia: Monitoring and Emergency Therapy In: Muir WW, Hubbell JAE, editors. St. Louis, Missouri: Saunders; (2009). p. 11–36.
- Rainger JE, Dart CM, Perkins NR. Factors affecting the relationship between arterial and end-tidal carbon dioxide pressures in the anaesthetised horse.. Aust Vet J 2010 Jan;88(1-2):13-9.
- Neto FJ, Luna SP, Massone F, Thomassian A, Vargas JL, Junior JR, D'Utra Vaz BB, Crocci AJ. The effect of changing the mode of ventilation on the arterial-to-end-tidal CO2 difference and physiological dead space in laterally and dorsally recumbent horses during halothane anesthesia.. Vet Surg 2000 Mar-Apr;29(2):200-5.
- Meyer RE, Short CE. Arterial to end-tidal CO2 tension and alveolar dead space in halothane- or isoflurane-anesthetized ponies.. Am J Vet Res 1985 Mar;46(3):597-9.
- Ambrisko TD, Schramel J, Hopster K, Kästner S, Moens Y. Assessment of distribution of ventilation and regional lung compliance by electrical impedance tomography in anaesthetized horses undergoing alveolar recruitment manoeuvres.. Vet Anaesth Analg 2017 Mar;44(2):264-272.
- Mosing M, Auer U, MacFarlane P, Bardell D, Schramel JP, Böhm SH, Bettschart-Wolfensberger R, Waldmann AD. Regional ventilation distribution and dead space in anaesthetized horses treated with and without continuous positive airway pressure: novel insights by electrical impedance tomography and volumetric capnography.. Vet Anaesth Analg 2018 Jan;45(1):31-40.
Citations
This article has been cited 8 times.- Raidal SL, Catanchin M, Sacks M, Carstens A, Quinn C, Mosing M. Effects of 2 modes of positive pressure ventilation on respiratory mechanics and gas exchange in foals.. J Vet Intern Med 2023 May-Jun;37(3):1233-1242.
- Sacks M, Raidal S, Catanchin CSM, Hosgood G, Mosing M. Impact of sedation, body position change and continuous positive airway pressure on distribution of ventilation in healthy foals.. Front Vet Sci 2022;9:1075791.
- Moreno-Martinez F, Byrne D, Raisis A, Waldmann AD, Hosgood G, Mosing M. Comparison of Effects of an Endotracheal Tube or Facemask on Breathing Pattern and Distribution of Ventilation in Anesthetized Horses.. Front Vet Sci 2022;9:895268.
- Machado ML, Soares JHN, Pypendop BH, Aguiar AJA, Braun C, Motta-Ribeiro GC, Jandre FC. Cardiovascular and Gas Exchange Effects of Individualized Positive End-Expiratory Pressures in Cats Anesthetized With Isoflurane.. Front Vet Sci 2022;9:865673.
- Lecompte-Osorio P, Pearson SD, Pieroni CH, Stutz MR, Pohlman AS, Lin J, Hall JB, Htwe YM, Belvitch PG, Dudek SM, Wolfe K, Patel BK, Kress JP. Bedside estimates of dead space using end-tidal CO(2) are independently associated with mortality in ARDS.. Crit Care 2021 Sep 15;25(1):333.
- Stefanik E, Drewnowska O, Lisowska B, Turek B. Causes, Effects and Methods of Monitoring Gas Exchange Disturbances during Equine General Anaesthesia.. Animals (Basel) 2021 Jul 9;11(7).
- Crivellari B, Raisis A, Hosgood G, Waldmann AD, Murphy D, Mosing M. Use of Electrical Impedance Tomography (EIT) to Estimate Tidal Volume in Anaesthetized Horses Undergoing Elective Surgery.. Animals (Basel) 2021 May 10;11(5).
- de Lacy FB, Taurà P, Arroyave MC, Trépanier JS, Ríos J, Bravo R, Ibarzabal A, Pena R, Deulofeu R, Lacy AM. Impact of pneumoperitoneum on intra-abdominal microcirculation blood flow: an experimental randomized controlled study of two insufflator models during transanal total mesorectal excision : An experimental randomized multi-arm trial with parallel treatment design.. Surg Endosc 2020 Oct;34(10):4494-4503.
Use Nutrition Calculator
Check if your horse's diet meets their nutrition requirements with our easy-to-use tool Check your horse's diet with our easy-to-use tool
Talk to a Nutritionist
Discuss your horse's feeding plan with our experts over a free phone consultation Discuss your horse's diet over a phone consultation
Submit Diet Evaluation
Get a customized feeding plan for your horse formulated by our equine nutritionists Get a custom feeding plan formulated by our nutritionists