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Measurement of Cardiac Output by Alveolar Gas Exchange

Marvin A. Sackner

10.1002/cphy.cp030413

Source: Supplement 13: Handbook of Physiology, The Respiratory System, Gas Exchange

Originally published: 1987

Published online: January 2011

Full Article on Wiley Online Library



Abstract

The sections in this article are:

1 Measurement of Pulmonary Capillary Blood Flow With Physiological Gases
1.1 Measurement With O2
1.2 Measurement With CO2
2 Measurement of Pulmonary Capillary Blood Flow with Chemically Inert Soluble Gases
2.1 Rebreathing, Multiple‐Breath‐Hold, and Single‐Breath Constant Expiratory Methods
2.2 Body Plethysmographic Methods
2.3 Substitution of Thorax for Body Plethysmograph
2.4 Vital Capacity N2O Spirometric Method
3 Summary
Figure 1. Figure 1.

Alveolar gas tensions in the resting subject. Three normal expirations breathing air are followed by the rebreathing maneuver, with inspired O2 falling to zero during first inspiration from the bag containing 8% CO2 in N2. Plateau obtained 7 s after this inspiration is maintained for 6 s. In practice, sensitivity of O2 channel is increased during measurement of equilibrium value. , partial pressure of O2; , partial pressure of CO2.

From Cerretelli et al. 14
Figure 2. Figure 2.

Records of partial pressure of CO2 () during rebreathing. Four different patterns are shown, obtained with successively increasing initial bag CO2 concentrations in a normal subject exercising at a work load of (600 kp·m)/min (CO2 output 1.5 liters/min). Pattern C, a sustained equilibrium; patterns A and B, unsustained, phase reversal, which occurs at a lower ; pattern D, delayed equilibrium at a higher . Despite wide variation in initial bag , after 10‐s rebreathing is similar and 6 mmHg separates the 10‐s end‐tidal value of the two extremes (A and D).

From Jones et al. 49. Reprinted by permission from Clinical Science, © 1967, The Biochemical Society, London
Figure 3. Figure 3.

Mass spectrometer record of expired CO2 showing increase in slope of alveolar with increasing exercise. , arterial . , end‐tidal .

From Jones et al. 50
Figure 4. Figure 4.

Linear relationship between of arterial blood () and the instantaneous exchange ratio R when the breath is held for one circulation time. Oxyg. , oxygenated mixed venous .

From Kim et al. 56
Figure 5. Figure 5.

Partial pressure of CO2 versus typical expiration against an airway resistor. Curve. I, 3rd‐order polynomial fit to all 405 data points. Curve II, polynomial fit after deletion of 25 data points to right of line a. Curve III, polynomial fit after deletion of 50 data points to left of line b in addition to those to right of line a.

From Hlastala et al. 44
Figure 6. Figure 6.

Partial pressure of CO2 at the mouth versus time. PAo, end‐expiratory CO2 pressure of the last control breath. T, time required for alveolar to return to PAo after the initial fall.

From Farhi et al. 26
Figure 7. Figure 7.

Carbon monoxide disappearance curve in a normal subject obtained with multiple‐breath‐holding times. •, Individual data points; +, another data point that might be used to calculate a single‐breath diffusing capacity (DL), in which breath‐holding varies between 8 and 12 s; ‐ ‐ ‐ ‐, slope used for calculation of the latter, because it was assumed that the zero intercept was unity. Because the value at unity was actually +0.7 s, the standard calculation in this example underestimated diffusing capacity by 9%. VA, alveolar volume; FAco, alveolar fraction of CO; , intercept value of FAco.

From Sackner et al. 80
Figure 8. Figure 8.

Displays of computer cathode‐ray oscilloscope data from a normal subject, giving a lung volume of 3.16 liters, of 324 ml/min, CO diffusing capacity of 36.7 ml CO · min−1 · Torr−1, C2H2 of 6.37 liters/min, C2H2 pulmonary tissue plus capillary blood volume (Vti,c) of 564 ml, and dimethyl ether pulmonary Vti,c of 467 ml. A: helium tracing during rebreathing. Oscillations are minimal by third breath. B: C18O tracing during rebreathing; vertical lines, which delineate least‐squares best fit of data, are under program control and modification by operator. Lines are midway between inspiratory and expiratory C18O excursion over an interval of 3 breaths. Incorrect placement of cursors at trough of first and peak of last of these 3 breaths changed least‐squares‐fit equation to effect an increase in C2H2 pulmonary Vti,c of 6%, a decrease in dimethyl ether pulmonary Vti,c of 4%, a fall in C2H2 of 11%, and a fall in diffusing capacity of 12%. C: C18O disappearance curve with least‐squares‐fit line; real time 0 does not intercept at unity. D: C2H2 disappearance curve with least‐squares‐fit line; time 0 is 1.58 s after beginning of rebreathing corrected from C18O intercept of 1.0. Pulmonary Vti,c corrected for time by C18O is 564 ml compared with 404 ml with a real time 0. E: ethyl iodide (EI) disappearance curve with its least‐squares‐fit line. F: dimethyl ether (DME) disappearance curve with its least‐squares‐fit line. Time 0 is 1.58 s after beginning of rebreathing. Pulmonary Vti,c corrected for time by C18O is 457 ml compared with 318 ml with real time 0.

From Sackner et al. 81
Figure 9. Figure 9.

Theoretical change in pulmonary Vti,c (VT) on calculation of . Initial value of was taken as 6 liters/min and pulmonary Vti,c as 500 ml. data were calculated by keeping the slope of disappearance curves of C2H2 and dimethyl ether (DME) constant while varying the value of pulmonary Vti,c. Diagram shows that C2H2 values are relatively insensitive to changes in pulmonary Vti,c compared with dimethyl ether .

From Sackner et al. 81
Figure 10. Figure 10.

N2O plethysmograph‐flowmeter record obtained from a patient with atrioventricular dissociation. The calculated beat‐by‐beat variation of right ventricular stroke volume (S. V., milliliters) is shown below each cardiac cycle.

From Bosman et al. 10. Reprinted by permission from Clinical Science, © 1964, The Biochemical Society, London
Figure 11. Figure 11.

Flow body plethysmograph. Airflow into box to replace N2O (○) absorbed is measured by the flowmeter (rate of box flow). Rate of inhalation from or exhalation into bag containing N2O is measured by the other flowmeter (rate of breathing). Concentration of N2O at lips is measured by an infrared analyzer.

From Vermeire and Butler 89, by permission of the American Heart Association, Inc
Figure 12. Figure 12.

Computer display (upper right) of average pulmonary capillary blood flow pulse from 6 supine normal subjects together with the Fourier analysis. Two vertical bars, R‐R interval; y‐axis, blood flow in liters per minute; x‐axis, time in seconds. HR, heart rate; SV, stroke volume; CO, mean pulmonary capillary blood flow; PO, peak pulmonary capillary blood flow. Bar graph (left), Fourier analysis: y‐axis, percent of total harmonic content; x‐axis, harmonics from 1 to 30.

From Sackner et al. 75
Figure 13. Figure 13.

Effect of respiration on pulmonary capillary blood flow. Plethysmographic tracing during one respiratory cycle. Control (air) box flow and volume recordings are traced on the N2O record. Difference between 2 box flow tracings represents instantaneous capillary blood flow.

From Astrom et al. 2
Figure 14. Figure 14.

Effects of tilting from supine (0°) to vertical position (90°) on pulmonary capillary blood flow (), heart rate, stroke volume, peak systolic flow (PSF), end‐diastolic flow (EDF), and capillary pulse amplitude (CPA). Values are means in 4 normal subjects. Vertical bars, standard deviations.

From Segel et al. 84
Figure 15. Figure 15.

Typical record of a well‐trained subject during breath holding after a breath of air (A) and N2O (B). Horizontal lines drawn on the pneumograph tracing indicate that breath holding was precise. Lines perpendicular to x‐axis are drawn to the spirometer tracing through corresponding points of successive heartbeats. Slope drawn through points where perpendiculars intercept the spirometer tracing is a measure of the net rate of gas exchange. Spirometer tracing was replaced in position when it reached the lower edge of the record. , capillary blood flow; SV, stroke volume; f, frequency; , alveolar fraction of N2O.

From Wasserman and Comroe 91
Figure 16. Figure 16.

Computer displays of pneumotachographic tracings at airway in an anesthetized, paralyzed patient. Upper left, air pulse; upper right, N2O pulse. Bottom: pulmonary capillary blood flow () obtained by subtracting air pulse from N2O pulse and converting to through the standard N2O equation; y‐axis, in liters/minute; and x‐axis, time in seconds. Vertical bars, R‐R interval of electrocardiogram.

From Greenberg et al. 39


Figure 1.

Alveolar gas tensions in the resting subject. Three normal expirations breathing air are followed by the rebreathing maneuver, with inspired O2 falling to zero during first inspiration from the bag containing 8% CO2 in N2. Plateau obtained 7 s after this inspiration is maintained for 6 s. In practice, sensitivity of O2 channel is increased during measurement of equilibrium value. , partial pressure of O2; , partial pressure of CO2.

From Cerretelli et al. 14


Figure 2.

Records of partial pressure of CO2 () during rebreathing. Four different patterns are shown, obtained with successively increasing initial bag CO2 concentrations in a normal subject exercising at a work load of (600 kp·m)/min (CO2 output 1.5 liters/min). Pattern C, a sustained equilibrium; patterns A and B, unsustained, phase reversal, which occurs at a lower ; pattern D, delayed equilibrium at a higher . Despite wide variation in initial bag , after 10‐s rebreathing is similar and 6 mmHg separates the 10‐s end‐tidal value of the two extremes (A and D).

From Jones et al. 49. Reprinted by permission from Clinical Science, © 1967, The Biochemical Society, London


Figure 3.

Mass spectrometer record of expired CO2 showing increase in slope of alveolar with increasing exercise. , arterial . , end‐tidal .

From Jones et al. 50


Figure 4.

Linear relationship between of arterial blood () and the instantaneous exchange ratio R when the breath is held for one circulation time. Oxyg. , oxygenated mixed venous .

From Kim et al. 56


Figure 5.

Partial pressure of CO2 versus typical expiration against an airway resistor. Curve. I, 3rd‐order polynomial fit to all 405 data points. Curve II, polynomial fit after deletion of 25 data points to right of line a. Curve III, polynomial fit after deletion of 50 data points to left of line b in addition to those to right of line a.

From Hlastala et al. 44


Figure 6.

Partial pressure of CO2 at the mouth versus time. PAo, end‐expiratory CO2 pressure of the last control breath. T, time required for alveolar to return to PAo after the initial fall.

From Farhi et al. 26


Figure 7.

Carbon monoxide disappearance curve in a normal subject obtained with multiple‐breath‐holding times. •, Individual data points; +, another data point that might be used to calculate a single‐breath diffusing capacity (DL), in which breath‐holding varies between 8 and 12 s; ‐ ‐ ‐ ‐, slope used for calculation of the latter, because it was assumed that the zero intercept was unity. Because the value at unity was actually +0.7 s, the standard calculation in this example underestimated diffusing capacity by 9%. VA, alveolar volume; FAco, alveolar fraction of CO; , intercept value of FAco.

From Sackner et al. 80


Figure 8.

Displays of computer cathode‐ray oscilloscope data from a normal subject, giving a lung volume of 3.16 liters, of 324 ml/min, CO diffusing capacity of 36.7 ml CO · min−1 · Torr−1, C2H2 of 6.37 liters/min, C2H2 pulmonary tissue plus capillary blood volume (Vti,c) of 564 ml, and dimethyl ether pulmonary Vti,c of 467 ml. A: helium tracing during rebreathing. Oscillations are minimal by third breath. B: C18O tracing during rebreathing; vertical lines, which delineate least‐squares best fit of data, are under program control and modification by operator. Lines are midway between inspiratory and expiratory C18O excursion over an interval of 3 breaths. Incorrect placement of cursors at trough of first and peak of last of these 3 breaths changed least‐squares‐fit equation to effect an increase in C2H2 pulmonary Vti,c of 6%, a decrease in dimethyl ether pulmonary Vti,c of 4%, a fall in C2H2 of 11%, and a fall in diffusing capacity of 12%. C: C18O disappearance curve with least‐squares‐fit line; real time 0 does not intercept at unity. D: C2H2 disappearance curve with least‐squares‐fit line; time 0 is 1.58 s after beginning of rebreathing corrected from C18O intercept of 1.0. Pulmonary Vti,c corrected for time by C18O is 564 ml compared with 404 ml with a real time 0. E: ethyl iodide (EI) disappearance curve with its least‐squares‐fit line. F: dimethyl ether (DME) disappearance curve with its least‐squares‐fit line. Time 0 is 1.58 s after beginning of rebreathing. Pulmonary Vti,c corrected for time by C18O is 457 ml compared with 318 ml with real time 0.

From Sackner et al. 81


Figure 9.

Theoretical change in pulmonary Vti,c (VT) on calculation of . Initial value of was taken as 6 liters/min and pulmonary Vti,c as 500 ml. data were calculated by keeping the slope of disappearance curves of C2H2 and dimethyl ether (DME) constant while varying the value of pulmonary Vti,c. Diagram shows that C2H2 values are relatively insensitive to changes in pulmonary Vti,c compared with dimethyl ether .

From Sackner et al. 81


Figure 10.

N2O plethysmograph‐flowmeter record obtained from a patient with atrioventricular dissociation. The calculated beat‐by‐beat variation of right ventricular stroke volume (S. V., milliliters) is shown below each cardiac cycle.

From Bosman et al. 10. Reprinted by permission from Clinical Science, © 1964, The Biochemical Society, London


Figure 11.

Flow body plethysmograph. Airflow into box to replace N2O (○) absorbed is measured by the flowmeter (rate of box flow). Rate of inhalation from or exhalation into bag containing N2O is measured by the other flowmeter (rate of breathing). Concentration of N2O at lips is measured by an infrared analyzer.

From Vermeire and Butler 89, by permission of the American Heart Association, Inc


Figure 12.

Computer display (upper right) of average pulmonary capillary blood flow pulse from 6 supine normal subjects together with the Fourier analysis. Two vertical bars, R‐R interval; y‐axis, blood flow in liters per minute; x‐axis, time in seconds. HR, heart rate; SV, stroke volume; CO, mean pulmonary capillary blood flow; PO, peak pulmonary capillary blood flow. Bar graph (left), Fourier analysis: y‐axis, percent of total harmonic content; x‐axis, harmonics from 1 to 30.

From Sackner et al. 75


Figure 13.

Effect of respiration on pulmonary capillary blood flow. Plethysmographic tracing during one respiratory cycle. Control (air) box flow and volume recordings are traced on the N2O record. Difference between 2 box flow tracings represents instantaneous capillary blood flow.

From Astrom et al. 2


Figure 14.

Effects of tilting from supine (0°) to vertical position (90°) on pulmonary capillary blood flow (), heart rate, stroke volume, peak systolic flow (PSF), end‐diastolic flow (EDF), and capillary pulse amplitude (CPA). Values are means in 4 normal subjects. Vertical bars, standard deviations.

From Segel et al. 84


Figure 15.

Typical record of a well‐trained subject during breath holding after a breath of air (A) and N2O (B). Horizontal lines drawn on the pneumograph tracing indicate that breath holding was precise. Lines perpendicular to x‐axis are drawn to the spirometer tracing through corresponding points of successive heartbeats. Slope drawn through points where perpendiculars intercept the spirometer tracing is a measure of the net rate of gas exchange. Spirometer tracing was replaced in position when it reached the lower edge of the record. , capillary blood flow; SV, stroke volume; f, frequency; , alveolar fraction of N2O.

From Wasserman and Comroe 91


Figure 16.

Computer displays of pneumotachographic tracings at airway in an anesthetized, paralyzed patient. Upper left, air pulse; upper right, N2O pulse. Bottom: pulmonary capillary blood flow () obtained by subtracting air pulse from N2O pulse and converting to through the standard N2O equation; y‐axis, in liters/minute; and x‐axis, time in seconds. Vertical bars, R‐R interval of electrocardiogram.

From Greenberg et al. 39
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Article Title: Measurement of Cardiac Output by Alveolar Gas Exchange
 

How to Cite

Marvin A. Sackner. Measurement of Cardiac Output by Alveolar Gas Exchange. Compr Physiol 2011, Supplement 13: Handbook of Physiology, The Respiratory System, Gas Exchange: 233-255. First published in print 1987. doi: 10.1002/cphy.cp030413