• Gabriel C Motta-Ribeiro, Vidal MeloMarcos FMFDepartment of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA., and Frederico C Jandre.
• Biomedical Engineering Programme, COPPE, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil.
• J Clin Monit Comput. 2020 Dec 1; 34 (6): 1265-1274.

AbstractTo evaluate a compact and easily interpretable 4-parameter model describing the shape of the volumetric capnogram, and the resulting estimates of anatomical dead space (VDAW) and Phase III (alveolar plateau) slope (SIII). Data from of 8 mildly-endotoxemic pre-acute respiratory distress syndrome sheep were fitted to the proposed 4-parameter model (4p) and a previously established 7-parameter model (7p). Root mean square error (RMSE) and Akaike information criterion (AIC), as well as VDAW and SIII derived from each model were compared. Confidence intervals for model's parameters, VDAW and SIII were estimated with a jackknife approach. RMSE values were similar (4p: 1.13 ± 0.01 mmHg vs 7p: 1.14 ± 0.01 mmHg) in the 791 breath cycles tested. However, the 7p overfitted the curve and had worse AIC in more than 50% of the cycles (p < 0.001). The large number of degrees of freedom also resulted in larger between-animal range of confidence intervals for 7p (VDAW: from 6.1 10-12 to 34 ml, SIII: from 9.53 10-7 to 1.80 mmHg/ml) as compared to 4p (VDAW: from 0.019 to 0.15 ml, SIII: from 3.9 10-4 to 0.011 mmHg/ml). Mean differences between VDAW (2.1 ± 0.04 ml) and SIII (0.047 ± 0.004 mmHg/ml) from 7 and 4p were significant (p < 0.001), but within the observed cycle-by-cycle variability. The proposed 4-parameter model of the volumetric capnogram improves data fitting and estimation of VDAW and SIII as compared to the 7-parameter model of reference. These advantages support the use of the 4-parameter model in future research and clinical applications.

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