Minimally invasive estimation of ventricular dead space volume through use of Frank-Starling curves

This paper develops a means of more easily and less invasively estimating ventricular dead space volume (V(d)), an important, but difficult to measure physiological parameter. V(d) represents a subject and condition dependent portion of measured ventricular volume that is not actively participating in ventricular function. It is employed in models based on the time varying elastance concept, which see widespread use in haemodynamic studies, and may have direct diagnostic use. The proposed method involves linear extrapolation of a Frank-Starling curve (stroke volume vs end-diastolic volume) and its end-systolic equivalent (stroke volume vs end-systolic volume), developed across normal clinical procedures such as recruitment manoeuvres, to their point of intersection with the y-axis (where stroke volume is 0) to determine V(d). To demonstrate the broad applicability of the method, it was validated across a cohort of six sedated and anaesthetised male Pietrain pigs, encompassing a variety of cardiac states from healthy baseline behaviour to circulatory failure due to septic shock induced by endotoxin infusion. Linear extrapolation of the curves was supported by strong linear correlation coefficients of R = 0.78 and R = 0.80 average for pre- and post- endotoxin infusion respectively, as well as good agreement between the two linearly extrapolated y-intercepts (V(d)) for each subject (no more than 7.8% variation). Method validity was further supported by the physiologically reasonable V(d) values produced, equivalent to 44.3–53.1% and 49.3–82.6% of baseline end-systolic volume before and after endotoxin infusion respectively. This method has the potential to allow V(d) to be estimated without a particularly demanding, specialised protocol in an experimental environment. Further, due to the common use of both mechanical ventilation and recruitment manoeuvres in intensive care, this method, subject to the availability of multi-beat echocardiography, has the potential to allow for estimation of V(d) in a clinical environment.