Reflection of differential pulmonary perfusion in polytrauma patients on differential lung ventilation (DLV). A comparison of two CO2-derived methods

Intensive Care Medicine
D F Zandstra, C P Stoutenbeek

Abstract

Seventeen polytrauma patients with asymmetric pulmonary contusion were treated with differential lung ventilation (DLV). The ratios of differential values of end-tidal CO2 concentration (ETCO2) and CO2 excretion ml/min (VCO2) were compared as indirect parameters for differential pulmonary perfusion. Both CO2-derived methods indicated asymmetry after starting DLV suggesting asymmetric pulmonary perfusion as a consequence of contusion. Prior to stopping DLV a significant improvement in asymmetry was indicated by the differential ratios of ETCO2 and VCO2 values. The ETCO2 ratio increased from 0.74 +/- 0.17 to 0.88 +/- 0.10, the VCO2 ratio from 0.57 +/- 0.23 to 0.86 +/- 0.11. In two patients with very severe contusion who underwent bilobectomies a marked difference between the ratios of ETCO2 and VCO2 was observed. It is concluded that differential measurement of CO2-derived variables may be useful in indicating differential perfusion in clinical practice on DLV. In very severe asymmetric contusion ETCO2 ratios may underestimate the differential perfusion ratio.

References

Oct 1, 1979·Journal of Applied Physiology: Respiratory, Environmental and Exercise Physiology·L OppenheimerL D Wood
Oct 1, 1979·Journal of Applied Physiology: Respiratory, Environmental and Exercise Physiology·K D CravenL D Wood
Jan 1, 1987·Intensive Care Medicine·D F Zandstra, C P Stoutenbeek
Jul 1, 1980·Medical & Biological Engineering & Computing·A GedeonE Romano
Jan 1, 1983·International Anesthesiology Clinics·K Geiger

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Citations

Jul 20, 2011·Journal of Emergencies, Trauma, and Shock·Torsten Richter, Maximilian Ragaller
Jan 19, 1999·Critical Care Clinics·A R Thomas, T L Bryce

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