Computer determination of thoracic gas volume using plethysmographic "thoracic flow".

Abstract

Plotting a line to the variables obtained during a panting maneuver, i.e. thoracic volume and mouth pressure, is the conventional way of computing plethysmographic thoracic gas volume (TGV). This procedure is reliable if the magnitude of the thoracic volume changes is large compared to the drift on the signal; this is one of the major problems in volumetric plethysmography. We propose replacing the thoracic volume signal (Vt) by its time derivative (Vt) and similarly mouth pressure (Pm) with its time derivative (Pm). Drift is thus ruled out, and the magnitude of Vt is preserved when the subject fails to carry out noticeable changes in thoracic volume during the panting, since even then the speed of these changes in thoracic volume remains high. The use of Vt and Pm appeared to be necessary when a minicomputer was connected to a pressure-compensated flow plethysmograph to obtain an automatic calculation of TGV. A regression-line technique applied to signals obtained during the panting was used to find the slope of the relation and thus TGV. However, this slope can only be predicted with less than 5% error if the correlation coefficient is very high (i.e., above 0.99). The analysis of 121 recordings from patients showed that the mean r was only 0.954 when Vt and Pm were used. It increased to 0.993 with Vt and Pm. For the same recordings the comparison of hand-calculated TGV and computer-derived TGV showed a much better agreement for the Vt-Pm method (standard error of the estimate (SEE) = 0.14 liter) than for the Vt-Pm method (SEE = 0.34 liter). These results emphasize that, in contrast to the manual technique, the computer does not adequately handle even a small drift of the thoracic signal. The proposed time-derivative method is therefore useful for a hand calculation, but essential to a reliable computer determination of thoracic gas volume