COMPUTERS IN CRITICAL CARE AND PULMONARY MEDICINE VOLUME 2 A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher. COMPUTERS IN CRITICAL CARE AND PULMONARY MEDICINE VOLUME 2 Edited by O. Prakash Erasmus University Rotterdam, The Netherlands Associate editors: A. A. Spence University of Glasgow Glasgow, United Kingdom J.P.Payne Royal College of Surgeons London, United Kingdom B. Jonson University of Lund Lund, Sweden S. Nair Yale University School of Medicine Connecticut, U.S.A. PLENUM PRESS· NEW YORK AND LONDON Proceedings of the Second International Symposium on Computers in Critical Care and Pulmonary Medicine, held June 3-6, 1980, in Lund, Sweden Secretary-general and chairman program committee B. Jonson, M.D., Lund, Sweden Chairman O. Prakash, M.D., Rotterdam, The Netherlands Co-chairman S. Nair, M.D., F.A.C.P ., Norwalk, Connecticut. U.S.A. STEERING COMMITTEE Dr. R. Imbruce, Bridgeport, U.S.A. Dr. J. Osborn, San Francisco, U.S.A. Dr. R. M. Peters, San Diego. U.S.A . Dr. R. M. Gardner, Utah, U.S.A. Dr. B. D. McLees, Bethesda, U.S.A . Dr . I. Slaw, Bridgeport, U.S.A. Coordinator Miss B. Richardson, Lund, Sweden © 1982 Plenum Press, New York Softcover reprint o ft he hardcover 1s t edition 1982 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved ISBN 978-1-4615-6706-6 ISBN 978-1-4615-6704-2 (.Book) 001 10.1007/978-1-4615-6704-2 PREFACE This volume, the second in a series on topics in microcomputers in critical care and pulmonary physiology,' contains the proceedings of the Second International Symposium on Computers in Critical Care and Pulmonary Medicine, held at the University of Lund in 1980 under the.,chairmanship of Prof. B. Jonson, M.D., Department of Clinical Physiology, University of Lund, Sweden. Clinicians and biomedical engineers from many countries parti- cipated in a three day deliberation. Of special interest was the introduction of nuclear techniques in pulmonary medicine for the first time in this symposium series. It is the intention of the steering committee that such meetings should take place on an annual basis in the rapidly changing world of the science and technology of computing in clinical care, in prac- tice and in pulmonary medicine. Editorial modification of the papers in this volume has been kept to a minimum. Changes have been made to ensure some uniformity in presentation and there has been some alteration of the English to avoid ambiguity, but our intervention has gone no further than that. It is hoped that the contents of this volume will enable those who are interested in the subject matter to be more aware of research developments occurring in so many different disciplines and so many different centres in America and Europe. Finally, I would like to thank Miss Bodil Richardson for her or- ganisational and secretarial help. Thanks are also due to Prof. J.P. Payne, Prof. A.A. Spence, Prof. B. Jonson and Prof. S. Nair for their helpful suggestions and assistance in editing this volume. O. Prakash v CONTENTS LUNG MODELS The Pathophysiology of Airways Disease 3 G. Cununing Computing Continuous Distributions from Limited Data IS P.D. Wagner Comparison of Different Methods of Mean Alveolar PC02 Measurement during Mechanical Ventilation: an Experimental and Theoretical Study 21 G. Boy, M.F. Forda, B. Renun, et al. Multicompartmental Analysis of Pulmonary Function Using System Identification Techniques 35 S. Olofsson and G. Hedensterna REGIONAL LUNG FUNCTION AND IMAGING Tomographic Imaging of Regional Lung Density by 90 0 Compton Scattering 41 M. Pistolesi, M. Miniati, S. Solfanelli, et al. Computer Analysis of Dynamic Krypton 81m Lung Scans in Infancy 45 C.Y.C. Wong and M. Silverman Comparison of Methods to Calculate Regional Lung Volume and Specific Alveolar Ventilation from Xenon-133 Wash-in Curves 47 Th.W. van der Mark, H. Beekhuis, R. Peset, et al. vii viii CONTENTS Identification Methods for Analysis of Xenon-133 Wash-out Curves: a Critical Comparative Study 49 V. Brusasco, A. Tiano, R. Astengo, et al. THE LUNG FUNCTION LABORATORY: SPIROMETRY MECHANICS AND RESPIRATION The Flow-Volume-Measurement in Computer-Supported Lung Function Analysis 57 C. Riemasch-Becker and K. Stosseck Comparison of Algorithms for the Diagnosis of Obstructive and Restrictive Lung Function Impairment 63 W. Arossa, S. Spinaci, A. Carosso, et al. An Automated System for the Measurement of Airways Resistance Lung Volume and Flow-Volume Loops 67 P.J. Chowienczyk, P.J. Rees and T.J.H. Clark Analysis of Body Plethysmographic Pressure-Flow- Loops by Digital Computer 71 D. Heise Non-Invasive Alveolar Pressure/Flow Pattern Deter- mination by Computerized Plethysmography 75 M.E. Perry, R.W. Zimmerer and R.J. Browning A New Method for Estimating Changes in Bronchomotor Tone Using the Apple Microcomputer 79 J.R. Lehane, C. Jordan, J.P. Royston and J.G. Jones Computer Analysis of Breathing Patterns 81 R.G. Loudon, A.G. Leitch, T.H. Ridgway, et al. Automatic Data Processing in the Clinical Lung- Function Laboratory 85 A.F.M. Verbraak, J.M. Bogaard, F.R.C. Jansen, et al. THE LUNG FUNCTION LABORATORY: GAS EXCHANGE On-Line Processing of Expiratory pC0 2-Curves for Diagnosis of Pulmonary Emphysema 91 U. Smidt and H. Worth Automatic Computation of Single Breath Nitrogen Test 95 P. Pisani, P. Paoletti, C. Marchesi, et al. CONTENTS ix Automated Measurement of Single-Breath Diffusing- Capacity (TLSB) ~n Routine Lung-Function Testing 99 M. Heitz, M. Kung, A. Perruchoud, et al. Blood Gas Analysis-Graphical Data Representation by Computer Application 101 E. Voigt A Computer Program for the Lung-Function Laboratory 105 P. Malmberg and K. Rasmundson NEW TECHNIQUES IN THE LABORATORY AND INTENSIVE CARE UNIT The Solitary Pulmonary Nodule Decision Analysis 109 R. Kunstatter, N. Wolkove, H. Kreisman, et al. Computer-Assisted Analysis of Transthoracic Impedances 113 R. Duranteau, B. Auvert, B. Dautzenberg, et al. Prediction of Tissue Perfusion a~d Heat Generation Rates by an Improved Heat Clearance Technique 117 R.C. Eberhart, A.B. Elkowitz and A. Shitzer Semiconductor Electrolyte Analysis: Progress Towards Indwelling Chemical Sensors 121 R.C. Eberhart, T.I. Thomasson, R. Sken, K. Wiemer, G. Cumming, M. Judy and G. Szabo The System for Quantitating Thermal-Dye Extra- Vascular Lung Water 123 U. Pfeiffer, M. Birk, G. Aschenbrenner, et al. The Gated Phonocardiogram: a Method of Digital Enhancement 127 S.B. Pett, Jr., R. Halsall, E.I. Hoover, et al. Exact BTPS-Compensation: A New Concept Realized with a Microcomputerized System 131 D. Rafalsky, H. Sieverts, P. Schwindke Relevant Diagnostical Information in Terminal Airway Structure from Computer Analysis of Expiratory Concentration Volume Diagrams 137 J. Vogel, F. Landser, G. Merker and B. Lachman x CONTENTS COMPUTER SYSTEMS IN THE INTENSIVE CARE UNIT System Design for the New Generation of Intensive Care Data Management Systems 143 T.J. Stafford, A.L. Miller and J.P. Payne Computerized Medical Decision Making - An Evaluation in Acute Care 147 R.M. Gardner, T.P. Clemmer and A.H. Morris Hierarchical Intermittent Respiratory Testing in the Intensive Care Unit 151 R.M. Peters, J.E. Brimm and S.R. Shackford New Possibilities in Paediatric Intensive Care 159 R. Frey, W. Bleicher, G. Budwig, et ale A Programme for Critical Care Ventilator Management 163 B.J. Rubin, J. Kunz, L. Fagan, et ale A Monitoring and Data Acquisition Program for Surgical Intensive Care 167 E. Munoz, A. Sims, J. Dawson, et ale Data System for Patients Requiring Artificial Ventilation 171 P.M. Osswald, H.J. Bender, H.J. Hartung, et ale New Aspects in Monitoring of Patients with Multiple Trauma in a Computer Assisted ICU 173 H. Junger, K. van Deyk, R. Weinmann, et ale Monitoring of Lung Function and Hemodynamics After Cardiac Surgery by Use of a Computer Assisted ICU 175 K. van Deyk, H. Junger, F. MUnch, et ale CLINICAL APPLICATIONS OF COMPUTERS IN THE INTENSIVE CARE UNIT Dead Space Analysis during Different Ventilator Settings: Use of the Single Breath Test for C02 179 R. Fletcher and B. Jonson A New Simple and Quick Method for Bedside Estimation of Functional Residual Capacity 183 W. Petro, W. Dams, J.A. Nakhosteen, et ale CONTENTS xi Validation of an Oxygen Wash-in Method for the Measurement of Functional Residual Capacity in the Intensive Care Unit 187 A.M. Benis, T.C. Commerton, R.R. Mitchell, et al. Continuous Distribution of Specific Tidal Volume and FRC from O2 and N2 Wash-in or Wash-out Data in ICU 191 M. Demeester, M. Pellegrini and Y. Delcambre Arterial C02 Tension Estimated Non-Invasively from End Forced Expired C02 Tension 193 M. Berthon-Jones, T.G. Nash, R. Simmul, et al. Breath-by-Breath End-Tidal Carbon Dioxide Analysis for Patients on Intermittent Mandatory Ventilation 195 J.E. Brimm, R.K. Brienzo, M.A. Knight, et al. An Interactive Computer Program for Weaning from Mechanical Ventilation 201 S. Meij, V. van der Borden and O. Prakash Feedback Controlled Ventilation 207 D.R. Westenskow, W.S. Jordan and K.B. Ohlson Determination of Optimum PEEP: Computerized Analysis of the Effect of Artificial Ventilation with Various Levels of PEEP 211 H. Mrochen, W. Kuckelt, R. Dauberschmidt, et al. Experience with a Computer-Activated Trend- Detection Alarm for Mean Arterial and Left Atrial Pressures 215 T.C. Commerton, A.M. Benis, H.L. Fitzkee, et al. Automatic Analysis of Circulatory Shunts during Articicial Ventilation 219 J.R.C. Jansen, J.M. Bogaard, R. Spritzer, et al. Dynamic Description of the Cardiac Performance during Intermittent positive Pressure Ventilation in Dogs 223 L. Sibille, F. Fraisse, J.M. Vallois, et al. Automated Continuous Respiratory Quotient Test 227 R.M. Peters, R.K. Brienzo and J.E. Brimm