Standardisation and application of the single-breath determination of nitric oxide uptake in the lung

Gerald S. Zavorsky, Connie C W Hsia, J. Michael B Hughes, Colin D R Borland, Hervé Guénard, Ivo Van Der Lee, Irene Steenbruggen, Robert Naeije, Jiguo Cao, Anh Tuan Dinh-Xuan

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Abstract

Diffusing capacity of the lung for nitric oxide (DLNO), otherwise known as the transfer factor, was first measured in 1983. This document standardises the technique and application of single-breath DLNO. This panel agrees that 1) pulmonary function systems should allow for mixing and measurement of both nitric oxide (NO) and carbon monoxide (CO) gases directly from an inspiratory reservoir just before use, with expired concentrations measured from an alveolar "collection" or continuously sampled via rapid gas analysers; 2) breath-hold time should be 10 s with chemiluminescence NO analysers, or 4-6 s to accommodate the smaller detection range of the NO electrochemical cell; 3) inspired NO and oxygen concentrations should be 40-60 ppm and close to 21%, respectively; 4) the alveolar oxygen tension (PAO2) should be measured by sampling the expired gas; 5) a finite specific conductance in the blood for NO (θNO) should be assumed as 4.5 mL·min-1·mmHg-1·mL-1 of blood; 6) the equation for 1/θCO should be (0.0062·PAO2+1.16)·(ideal haemoglobin/measured haemoglobin) based on breath-holding PAO2 and adjusted to an average haemoglobin concentration (male 14.6 g·dL-1, female 13.4 g·dL-1); 7) a membrane diffusing capacity ratio (DMNO/DMCO) should be 1.97, based on tissue diffusivity.

Original languageEnglish (US)
Article number1600962
JournalEuropean Respiratory Journal
Volume49
Issue number2
DOIs
StatePublished - Feb 1 2017

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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    Zavorsky, G. S., Hsia, C. C. W., Hughes, J. M. B., Borland, C. D. R., Guénard, H., Van Der Lee, I., Steenbruggen, I., Naeije, R., Cao, J., & Dinh-Xuan, A. T. (2017). Standardisation and application of the single-breath determination of nitric oxide uptake in the lung. European Respiratory Journal, 49(2), [1600962]. https://doi.org/10.1183/13993003.00962-2016