We have stated in (18) that M A is equal to the mean of the measured sinusoid FE′FE′. Substituting (22) and (18) into (21), we have an expression for VQVQ equation(23) VQ=Q˙Pλb(FE′,n−MA)Tn.Here we have reached expressions OSI-906 research buy for VIVI, VEVE, and VQVQ in Eqs. (17), (20) and (23), respectively. Substituting them into the right-hand-side of (14), and substituting (18) into the left-hand-side of (14), we have equation(24) VAFE′,n−1−FE′,n+Q˙PλbMA−FE′,nTn=VT,nFE′,n−VDFE′,n−1+∫tbIteI−TDIV˙(t)FI,n(t)dt.This is the conservation of mass equation
for the lung variables that we aim to estimate, expressed in terms of volume change of the indicator gas in a breath-by-breath manner. Our goal is to determine the values of V A and Q˙P in (24). The measured variables are FE′,n−1FE′,n−1, FE′,nFE′,n, F I,n(t ), V T,n, and M A; the blood solubility coefficient λ b is a known constant for the chosen indicator gas. We have previously used the Bohr equation to calculate V D ( Clifton et al., 2009); here V D is calculated using the method proposed in Section 4 where both CO2 and the indicator gas were used to achieve a robust estimate of V D. Using (24), every two successive breaths produce an equation; therefore a total of N breaths results in N − 1 equations of two unknown values, V A and Q˙P. For this set of N − 1 linear equations, we used the least-squares technique
to determine the values of V A and Q˙P. Early ventilators such as the Servo 900 (Siemens) were capable of being driven by an auxiliary low pressure gas supply, and so could be fed
by a gas mixer generating Sorafenib mouse sinusoidal indicator concentrations. However, modern ICU ventilators cannot be adapted easily to allow premixed gases to be delivered. Consequently, the indicator gas must be injected into the inspiratory limb of the ventilator “on the fly”. We adapted a novel on-line indicator gas delivery method (Farmery, 2008), where the indicator gas is injected into the patient’s inspiratory breathing flow and mixed in real time immediately before entering the mouth. Two types of indicator gases, O2 and N2O, are injected simultaneously into the patient’s airway flow during inspiration. Two mass flow controllers (MFC, Alicat Scientific, Inc., Thymidylate synthase USA) were used to deliver the two indicator gases at rates proportional to the subject’s inspiratory flow rate at any instant such that the indicator concentration remained constant within the breath, but could be forced to vary between breaths according to equation(25) FN2O(t)=MN2O+ΔFN2Osin(2πft)FN2O(t)=MN2O+ΔFN2Osin(2πft) equation(26) FO2(t)=MO2+ΔFO2sin(2πft),FO2(t)=MO2+ΔFO2sin(2πft),where FN2O(t)FN2O(t) is the concentration of the injected N2O flow; MN2OMN2O and ΔFN2OΔFN2O are the mean and amplitude of the forcing N2O sinusoid, respectively; FO2(t)FO2(t), MO2MO2, and ΔFO2ΔFO2 are similar denotations for O2. Fig. 2 shows the resulting concentration of the indicator gas O2.