Regional Ventilation

Delay - Interpreting the

Yellow Spots
Eckhard Teschner - October 2020, Lübeck

Drägerwerk AG & Co. KGaA, 2020

 Regional Ventilation Delay (RVD)
A novel parameter for assessing the lung function
Origin of the RVD parameter

The Regional Ventilation Delay (RVD) describes the delay until the
respective regional impedance change exceeds a threshold of 40% of
its maximum value.
RVD refers to the global impedance waveform and is expressed as
percentage of the inflation time.

Drägerwerk AG & Co. KGaA, 2020 3

 PulmoVista 500 SW 1.20 – Diagnostic View
Calculation of Regional Ventilation Delay …
Calculation of RVD for each pixel
1. Ti start and Ti end moments are determined for every
section based on the global impedance waveform
2. The inspiration time Ti is calculated, i.e. the time period
between Ti start and Ti end
3. T40glob is determined
4. For each pixel, T40i is determined

Calculation of RVDi, representing the inspiratory delay of the observed pixel:

Note: If the value of the RVD parameter exceeds the RVD cut-off value set by the user,
the affected pixels are marked in yellow in the corresponding tidal image.
Drägerwerk AG & Co. KGaA, 2020
 PulmoVista 500 SW 1.20 – Diagnostic View
Display of RVD - Meaning of colors and parameters
Yellow pixels in the Tidal Images:

Depending on the RVD threshold, which can set be by the

user, all pixels of the tidal images exceeding the threshold
are displayed in yellow color.

When touching a Tidal Image in this view, a larger page opens

up, which provides - for each pixel - details on the temporal
dynamics during inspiration.

Yellow: Delayed regional vs. global inspiration

Green: Early regional vs. global inspiration

Below the image, a diagram presents the global waveform (white)

and the pixel waveform (yellow or green, respectively) of the
selected pixel.
Drägerwerk AG & Co. KGaA, 2020
 PulmoVista 500 SW 1.20 – Diagnostic View
RVD – Some guidance for clinical interpretation
If a Tidal Image shows pixels marked in yellow color (B), touch the corresponding
image in order to open the page RVD analysis (C).
Use this page for detailed assessment of the regional inspiratory, but also
expiratory dynamics.
The following conditions may cause inspiratory delays:
B
1. Cyclic opening and closing
Delayed regions
 are relatively small (D)
 are located in the transition zone between well ventilated
and non-ventilated areas (D)
 present a regional waveform (yellow) which shows often
(but not always!) both late opening and early closing (E)
relative to the global waveform (white)
 change with PEEP settings

Drägerwerk AG & Co. KGaA, 2020

 PulmoVista 500 SW 1.20 – Diagnostic View
RVD – Some guidance for clinical interpretation
If a Tidal Image shows pixels marked in yellow color (B), touch the corresponding
image in order to open the page RVD analysis (C). C
Use this page for detailed assessment of the regional inspiratory, but also
expiratory dynamics.
The following conditions may cause inspiratory delays: B
2. Large time constants
Delayed regions
 are relatively large (F)
 are not located in the dependent part next to collapsed areas (F)
 are also delayed during the entire expiratory phase (G), including
end of expiration
 are frequently seen in COPD patients

Drägerwerk AG & Co. KGaA, 2020

 PulmoVista 500 SW 1.20 – Diagnostic View
RVD – Some guidance for clinical interpretation
If a Tidal Image shows pixels marked in yellow color (B), touch the corresponding
image in order to open the page RVD analysis (C). C
Use this page for detailed assessment of the regional inspiratory, but also
expiratory dynamics.
The following conditions may cause inspiratory delays:
B

3. Pendelluft D
Delayed regions
 are large (D)
 are often located in ventral areas (D),
 present a regional waveform (yellow) with very late opening and
also late closing (E) relative to the global waveform (white)
E
 are independent from PEEP settings
 are frequently seen in the presence of patient-ventilator asynchrony

Drägerwerk AG & Co. KGaA, 2020

 PulmoVista 500 SW 1.20 – Diagnostic View
RVD – Some guidance for clinical interpretation …
4. Artefacts
Cardiac artefacts: Aortic artefacts:
Delayed regions are Delayed regions
 are located in the mediastinal region  are located in the aortic region
 present a regional waveform (yellow)  present a regional waveform (yellow)
which shows cardiac oscillations which shows aortic oscillations

To suppress those artefacts,

 Increase the section length to

5, better 10 breaths/section

 Set the cut-off of the LP filter for

RVD stepwise down from 80 to
30 bpm

Drägerwerk AG & Co. KGaA, 2020

 PulmoVista 500 SW 1.20 – Diagnostic View
Calculation of global RVD parameters
Global RVD parameters: RVD SD or RVD Ratio
 RVD SD (expressed as % of Tinsp) represents the inhomogeneity of the regional inspiratory time course within the ventilated area.
 RVD Ratio (expressed as % of NV) expresses the area being affected by RVD, relative to the ventilated area

Calculation of RVD standard deviation (RVD SD)

The parameter RVD SD (expressed as % of Tinsp) represents the inhomogeneity of the regional inspiratory time course within the ventilated area.

The parameter RVD SD is calculated as follows:

Calculation of RVD ratio (RVD Ratio)

The parameter RVD Ratio (expressed as % of NV) expresses the area being affected by RVD, by calculating the ratio of the number of “RVD – pixels”
(NRVD) to the total number of pixels (NV) within the ventilated area.

The parameter RVD Ratio is calculated as follows:

 Note: In contrast to RVD SD, the RVD Ratio strongly depends on the defined RVD threshold!

Drägerwerk AG & Co. KGaA, 2020

Drägerwerk AG & Co. KGaA, 2020