Capnogram slope and ventilation dead space parameters: comparison of mainstream and sidestream techniques A.L. Balogh, F. Petak, G.H. Fodor, J. Tolnai,

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Capnogram slope and ventilation dead space parameters: comparison of mainstream and sidestream techniques A.L. Balogh, F. Petak, G.H. Fodor, J. Tolnai, Z. Csorba, B. Babik British Journal of Anaesthesia Volume 117, Issue 1, Pages 109-117 (July 2016) DOI: 10.1093/bja/aew127 Copyright © 2016 The Author(s) Terms and Conditions

Fig 1 Representative time (top) and volumetric (bottom) mainstream (continuous traces) and sidestream (dashed traces) capnograms. British Journal of Anaesthesia 2016 117, 109-117DOI: (10.1093/bja/aew127) Copyright © 2016 The Author(s) Terms and Conditions

Fig 2 Sidestream capnogram curve (continuous line, left axis) together with the flow in the sampling tube (dashed line, right axis) in a representative patient. British Journal of Anaesthesia 2016 117, 109-117DOI: (10.1093/bja/aew127) Copyright © 2016 The Author(s) Terms and Conditions

Fig 3 Correlations between the phase III slopes in the time (a, SIII,T,MSvs SIII,T,SS) and volumetric domains (c, SIII,V,MSvs SIII,V,SS) obtained by mainstream (horizontal axis) and sidestream capnography (vertical axis), with the regression lines (dashed) and the lines of identity (continuous). Regression equations: SIII,T,SS=0.142+0.996·SIII,T,MS and SIII,V,SS=5.09+0.93·SIII,V,MS. The corresponding Bland–Altman plots are demonstrated on the right for the time (b, SIII,T,MSvs SIII,T,SS) and volumetric (d, SIII,V,MSvs SIII,V,SS) capnograms. The means of differences are −0.019 kPa s−1 and −0.55 kPa litre−1 (continuous), and the limits of agreement are 0.06 kPa s−1 and 0.63 kPa litre−1 (dashed) for the time and volumetric capnograms, respectively. Each data point represents one expiration. SIII,t,ms, phase III slope of time capnogram; SIII,v,ms, phase III slope of volumetric capnogram; SII,t,ms, phase II slope of time capnogram; SII,v,ms, phase II slope of volumetric capnogram; Vdf,ms/Vt, normalized Fowler dead space; Vdb,ms/Vt, normalized Bohr dead space; Vde,ms/Vt, normalized Enghoff dead space; Vs,ms/Vt, normalized difference between the Enghoff and Bohr dead spaces; Vt, tidal volume. British Journal of Anaesthesia 2016 117, 109-117DOI: (10.1093/bja/aew127) Copyright © 2016 The Author(s) Terms and Conditions

Fig 4 Correlations between phase II slopes in the time (a, SII,T,MSvs SII,T,SS) and volume domain (b, SII,V,MSvs SII,V,SS), angles α (c, αMSvs αSS) and Fowler's dead space indices (d, VDF,MS/VT vs VDF,SS/VT) obtained by mainstream (horizontal) and sidestream (vertical) capnography, with the regression lines (dashed) and the lines of identity (continuous). Regression equations: SII,T,SS=39+0.298·SII,T,MS, SII,V,SS=140.2+0.1·SII,V,MS, αSS =−0.84+1.05·αMS, and VDF,SS/VT=−22.3+1.52·VDF,MS/VT. Each data point represents one expiration. British Journal of Anaesthesia 2016 117, 109-117DOI: (10.1093/bja/aew127) Copyright © 2016 The Author(s) Terms and Conditions

Fig 5 Correlation between normalized dead space indices calculated according to Bohr (a, VDB,MS/VTvs VDB,SS/VT) and Enghoff (b, VDE,MS/VTvs VDE,SS/VT), and their difference [c, Vs,MS/VT=(VDE,MS–VDB,MS/VT) vs Vs,SS/VT=(VDE,SS–VDB,SS)/VT] obtained by mainstream (horizontal) and sidestream (vertical) capnography, with the regression line (dashed) and the line of identity (continuous). Regression equations: VDB,SS/VT=0.11+0.82·VDB,MS/VT, VDE,SS/VT=0.12+0.86·VDE,MS/VT, and Vs,SS/VT=0.034+0.774·Vs,MS/VT. (d) The corresponding Bland–Altman plot is demonstrated for Vs,MS/VT and Vs,SS/VT. The mean of differences is 6.17 (continuous), and the limit of agreement is 24.2 (dashed). Each data point represents one expiration. British Journal of Anaesthesia 2016 117, 109-117DOI: (10.1093/bja/aew127) Copyright © 2016 The Author(s) Terms and Conditions

Fig 6 Relative differences in dead space and pulmonary shunt parameters obtained with the two methods in patients with the lower (L, compliance <37 ml cm H2O−1) and higher (H, compliance >53 ml cm H2O−1) quartiles and medium (M) interquartile range. *P<0.05 vs H; #P<0.05 vs M. British Journal of Anaesthesia 2016 117, 109-117DOI: (10.1093/bja/aew127) Copyright © 2016 The Author(s) Terms and Conditions