A Realistic Validation Study of a New Nitrogen Multiple-Breath Washout System
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{"title"=>"A realistic validation study of a new nitrogen multiple-breath washout system", "type"=>"journal", "authors"=>[{"first_name"=>"Florian", "last_name"=>"Singer", "scopus_author_id"=>"37098203500"}, {"first_name"=>"Birgitta", "last_name"=>"Houltz", "scopus_author_id"=>"6602554993"}, {"first_name"=>"Philipp", "last_name"=>"Latzin", "scopus_author_id"=>"16203004400"}, {"first_name"=>"Paul", "last_name"=>"Robinson", "scopus_author_id"=>"12794088900"}, {"first_name"=>"Per", "last_name"=>"Gustafsson", "scopus_author_id"=>"34770872300"}], "year"=>2012, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "scopus"=>"2-s2.0-84860477440", "sgr"=>"84860477440", "pui"=>"364720849", "isbn"=>"1932-6203", "pmid"=>"22558338", "doi"=>"10.1371/journal.pone.0036083"}, "id"=>"0d103fbf-b618-38f6-bc06-914bb6794aa7", "abstract"=>"BACKGROUND: For reliable assessment of ventilation inhomogeneity, multiple-breath washout (MBW) systems should be realistically validated. We describe a new lung model for in vitro validation under physiological conditions and the assessment of a new nitrogen (N(2))MBW system. METHODS: The N(2)MBW setup indirectly measures the N(2) fraction (F(N2)) from main-stream carbon dioxide (CO(2)) and side-stream oxygen (O(2)) signals: F(N2) = 1-F(O2)-F(CO2)-F(Argon). For in vitro N(2)MBW, a double chamber plastic lung model was filled with water, heated to 37°C, and ventilated at various lung volumes, respiratory rates, and F(CO2). In vivo N(2)MBW was undertaken in triplets on two occasions in 30 healthy adults. Primary N(2)MBW outcome was functional residual capacity (FRC). We assessed in vitro error (√[difference](2)) between measured and model FRC (100-4174 mL), and error between tests of in vivo FRC, lung clearance index (LCI), and normalized phase III slope indices (S(acin) and S(cond)). RESULTS: The model generated 145 FRCs under BTPS conditions and various breathing patterns. Mean (SD) error was 2.3 (1.7)%. In 500 to 4174 mL FRCs, 121 (98%) of FRCs were within 5%. In 100 to 400 mL FRCs, the error was better than 7%. In vivo FRC error between tests was 10.1 (8.2)%. LCI was the most reproducible ventilation inhomogeneity index. CONCLUSION: The lung model generates lung volumes under the conditions encountered during clinical MBW testing and enables realistic validation of MBW systems. The new N(2)MBW system reliably measures lung volumes and delivers reproducible LCI values.", "link"=>"http://www.mendeley.com/research/realistic-validation-study-new-nitrogen-multiplebreath-washout-system", "reader_count"=>34, "reader_count_by_academic_status"=>{"Professor > Associate Professor"=>2, "Researcher"=>12, "Student > Doctoral Student"=>2, "Student > Ph. D. Student"=>3, "Student > Postgraduate"=>3, "Student > Master"=>5, "Other"=>2, "Student > Bachelor"=>5}, "reader_count_by_user_role"=>{"Professor > Associate Professor"=>2, "Researcher"=>12, "Student > Doctoral Student"=>2, "Student > Ph. D. Student"=>3, "Student > Postgraduate"=>3, "Student > Master"=>5, "Other"=>2, "Student > Bachelor"=>5}, "reader_count_by_subject_area"=>{"Engineering"=>3, "Unspecified"=>2, "Nursing and Health Professions"=>1, "Biochemistry, Genetics and Molecular Biology"=>1, "Mathematics"=>1, "Medicine and Dentistry"=>24, "Agricultural and Biological Sciences"=>1, "Sports and Recreations"=>1}, "reader_count_by_subdiscipline"=>{"Engineering"=>{"Engineering"=>3}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>24}, "Sports and Recreations"=>{"Sports and Recreations"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>1}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>2}}, "reader_count_by_country"=>{"Netherlands"=>2, "Chile"=>1}, "group_count"=>1}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/646566"], "description"=>"<p>Triplicate nitrogen multiple-breath washout (N<sub>2</sub>MBW) tests applied to measure functional residual capacity (FRC) <i>in vitro</i> in the small<sup>*</sup> (n = 7) and the large<sup>†</sup> lung model (n = 41), and in 30 healthy adults<sup>‡</sup>. LCI = lung clearance index. S<sub>acin</sub> = phase III slope index of <i>acinar</i> ventilation inhomogeneity. S<sub>cond</sub> = phase III slope index of conductive ventilation inhomogeneity. CV = intra-test coefficient of variation (SD/mean*100). Mean difference<sup>§</sup> (95% confidence interval) from paired <i>t</i>-tests comparing measured and actual model FRC [<i>in vitro</i>] or N<sub>2</sub>MBW outcomes between two test occasions [<i>in vivo</i>]. CR = coefficient of repeatability (1.96*SD of differences between measured and actual model FRC or differences of N<sub>2</sub>MBW outcomes between tests). CR is given in respective units or as percentage of the mean. n.a. = not applicable.</p>", "links"=>[], "tags"=>["multiple-breath", "washout", "outcomes"], "article_id"=>317056, "categories"=>["Physiology", "Medicine", "Genetics"], "users"=>["Florian Singer", "Birgitta Houltz", "Philipp Latzin", "Paul Robinson", "Per Gustafsson"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0036083.t003", "stats"=>{"downloads"=>2, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Nitrogen_multiple_breath_washout_outcomes_and_variability_/317056", "title"=>"Nitrogen multiple-breath washout outcomes and variability.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-20 05:53:29"}
  • {"files"=>["https://ndownloader.figshare.com/files/646532"], "description"=>"<p>Oxygen and carbon dioxide and the derived nitrogen signals from the nitrogen multiple-breath washout setup were compared to mass spectrometer signals (AMIS 2000). Linear regression derived intercept (model offset), model slope (model gain) with respective 95% confidence intervals (CI), and R-squared (R<sup>2</sup>) are given.</p>", "links"=>[], "tags"=>["genetics and genomics", "physiology", "pediatrics and child health", "respiratory medicine"], "article_id"=>317019, "categories"=>["Physiology", "Medicine", "Genetics"], "users"=>["Florian Singer", "Birgitta Houltz", "Philipp Latzin", "Paul Robinson", "Per Gustafsson"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0036083.t002", "stats"=>{"downloads"=>3, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Linearity_of_sensors_/317019", "title"=>"Linearity of sensors.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-20 05:53:18"}
  • {"files"=>["https://ndownloader.figshare.com/files/646289"], "description"=>"<p>Functional residual capacity (FRC) measurement error (%) is plotted against lung model FRC. The error data are displayed as open circles for the small model (100–400 mL FRCs) and closed circles for the large model (500–4200 mL FRCs). The dashed line gives the 5% limit of acceptable measurement error, the dotted lines reflect possible nominal volume bias due to reading parallax error (one mm) in the small and large lung model.</p>", "links"=>[], "tags"=>["genetics and genomics", "physiology", "pediatrics and child health", "respiratory medicine"], "article_id"=>316780, "categories"=>["Physiology", "Medicine", "Genetics"], "users"=>["Florian Singer", "Birgitta Houltz", "Philipp Latzin", "Paul Robinson", "Per Gustafsson"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0036083.g003", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Association_of_measurement_error_with_lung_volume_/316780", "title"=>"Association of measurement error with lung volume.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 05:52:01"}
  • {"files"=>["https://ndownloader.figshare.com/files/646446"], "description"=>"<p><i>Bland Altman</i> plot <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0036083#pone.0036083-Bland1\" target=\"_blank\">[16]</a> of lung clearance index (LCI) measured on two study days within three weeks in 30 healthy adults. Absolute LCI differences (<a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0036083#pone-0036083-g005\" target=\"_blank\">Figure 5a</a>), relative LCI differences (<a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0036083#pone-0036083-g005\" target=\"_blank\">Figure 5b</a>), mean difference and upper and lower limits of agreement (lines) are plotted against mean LCI of both study days. Mean difference is −0.13 (−1.8%), upper and lower limits of agreement are 0.55 (7.6%) and −0.81 (−11.2%).</p>", "links"=>[], "tags"=>["variability", "clearance"], "article_id"=>316934, "categories"=>["Physiology", "Medicine", "Genetics"], "users"=>["Florian Singer", "Birgitta Houltz", "Philipp Latzin", "Paul Robinson", "Per Gustafsson"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0036083.g005", "stats"=>{"downloads"=>1, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_In_vivo_variability_of_lung_clearance_index_/316934", "title"=>"<i>In vivo</i> variability of lung clearance index.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 05:52:54"}
  • {"files"=>["https://ndownloader.figshare.com/files/646182"], "description"=>"<p><i>Bland Altman</i> plot <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0036083#pone.0036083-Bland1\" target=\"_blank\">[16]</a> of measured functional residual capacity (FRC) minus lung model FRC plotted vs. mean of measured and model FRC. Differences (open circles), and mean difference, and upper and lower limits of agreement (mean difference ±1.96 SD of differences) are given as dashed lines for the small lung model and as solid lines for the large lung model. <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0036083#pone-0036083-g002\" target=\"_blank\">Figure 2a</a> gives absolute FRC differences (mL). For the small and large lung model, mean differences are −10.2 mL and 12.5 mL, upper limits of agreement are 9.9 mL and 121.9 mL, and lower limits of agreement are −30.3 mL and −96.8 mL, respectively. <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0036083#pone-0036083-g002\" target=\"_blank\">Figure 2b</a> gives relative FRC differences (%). For the small and large lung model, mean differences are −3.8% and 0.4%, upper limits of agreement are 3.6% and 4.7%, and lower limits of agreements are −11.2% and −4.0%, respectively.</p>", "links"=>[], "tags"=>["variability", "residual"], "article_id"=>316673, "categories"=>["Physiology", "Medicine", "Genetics"], "users"=>["Florian Singer", "Birgitta Houltz", "Philipp Latzin", "Paul Robinson", "Per Gustafsson"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0036083.g002", "stats"=>{"downloads"=>0, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_In_vitro_variability_of_functional_residual_capacity_measurement_/316673", "title"=>"<i>In vitro</i> variability of functional residual capacity measurement.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 05:51:31"}
  • {"files"=>["https://ndownloader.figshare.com/files/646351"], "description"=>"<p><i>Bland Altman</i> plot <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0036083#pone.0036083-Bland1\" target=\"_blank\">[16]</a> of functional residual capacity (FRC) measured on two study days within three weeks in 30 healthy adults. Absolute FRC differences (<a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0036083#pone-0036083-g004\" target=\"_blank\">Figure 4a</a>), relative FRC differences (<a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0036083#pone-0036083-g004\" target=\"_blank\">Figure 4b</a>), mean difference and upper and lower limits of agreement (lines) are plotted against mean FRC of both tests. Mean difference is −15.4 mL (−1.1%), upper and lower limits of agreement are 793.3 mL (23.2%) and −824.1 mL (−25.4%).</p>", "links"=>[], "tags"=>["variability", "residual"], "article_id"=>316848, "categories"=>["Physiology", "Medicine", "Genetics"], "users"=>["Florian Singer", "Birgitta Houltz", "Philipp Latzin", "Paul Robinson", "Per Gustafsson"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0036083.g004", "stats"=>{"downloads"=>0, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_In_vivo_variability_of_functional_residual_capacity_/316848", "title"=>"<i>In vivo</i> variability of functional residual capacity.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 05:52:22"}
  • {"files"=>["https://ndownloader.figshare.com/files/646601"], "description"=>"<p>Functional residual capacity (FRC), tidal volume (V<sub>T</sub>), and respiratory rate (RR) generated in triplets are displayed as ranges. Respective dead space reducers (DSR 1–3) were applied to reduce post-capillary dead space to 1.5 mL, 16 mL, and 26.9 mL, respectively. Mean (range) intra-test coefficient of variation (CV) of generated nominal FRCs was 0.1 (0.0–1.8)%.</p>", "links"=>[], "tags"=>["genetics and genomics", "physiology", "pediatrics and child health", "respiratory medicine"], "article_id"=>317085, "categories"=>["Physiology", "Medicine", "Genetics"], "users"=>["Florian Singer", "Birgitta Houltz", "Philipp Latzin", "Paul Robinson", "Per Gustafsson"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0036083.t001", "stats"=>{"downloads"=>3, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Study_protocol_for_the_lung_model_/317085", "title"=>"Study protocol for the lung model.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-20 05:53:40"}
  • {"files"=>["https://ndownloader.figshare.com/files/646124"], "description"=>"<p>The lung and ventilation compartments are partly filled with distilled water, their volumes are 6.94 L and 11.72 L, respectively. The outer chamber's volume is 67.73 L, filled with distilled water and constantly heated to 37°C. The dashed line reflects the water level determining tidal volume and functional residual capacity (FRC) at in- and expiratory end-tidal levels. FRC is the volume of air contained in the model at end-tidal expiration. One mm on the tape measure corresponds to 18.7 mL volume. FRC range is 0.5–4.2 L. O<sub>2</sub> = sampling point of the side-stream oxygen sensor. CO<sub>2</sub> = sampling point of the main-stream carbon dioxide sensor. Flowhead = main-stream ultrasonic flowmeter.</p>", "links"=>[], "tags"=>["genetics and genomics", "physiology", "pediatrics and child health", "respiratory medicine"], "article_id"=>316614, "categories"=>["Physiology", "Medicine", "Genetics"], "users"=>["Florian Singer", "Birgitta Houltz", "Philipp Latzin", "Paul Robinson", "Per Gustafsson"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0036083.g001", "stats"=>{"downloads"=>0, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Schematic_drawing_of_the_lung_model_/316614", "title"=>"Schematic drawing of the lung model.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 05:51:10"}

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Relative Metric

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