The multiple inert gas elimination technique (MIGET) is a medical technique used mainly in pulmonology that involves measuring the concentrations of various infused, inert gases in mixed venous blood, arterial blood, and expired gas of a subject. The technique quantifies true shunt, physiological dead space ventilation, ventilation versus blood flow (VA/Q) ratios, and diffusion limitation.
Background Hypoxemia is generally attributed to one of four processes: hypoventilation, shunt (right to left), diffusion limitation, and ventilation/perfusion (VA/Q) inequality. Moreover, there are also "extrapulmonary" factors that can contribute to fluctuations in arterial PO2. There are several measures of hypoxemia that can be assessed, but there are various limitations associated with each. It was for this reason that the MIGET was developed, to overcome the shortcomings of previous methods.
Theoretical basis Steady-state gas exchange in the lungs obeys the principles of conservation of mass. This leads to the ventilation/perfusion equation for oxygen:
V A / Q = 8.63 × C c ′ O 2 − C v O 2 P I O 2 − P A O 2 {\displaystyle V_{A}/Q=8.63\times {\frac {C_{c'}{\ce {O2}}-C_{v}{\ce {O2}}}{P_{I}{\ce {O2}}-P_{A}{\ce {O2}}}}}
and for carbon dioxide:
V A / Q = 8.63 × C v CO 2 − C c ′ CO 2 P A CO 2 {\displaystyle V_{A}/Q=8.63\times {\frac {C_{v}{\ce {CO2}}-C_{c'}{\ce {CO2}}}{P_{A}{\ce {CO2}}}}}
where:
C c ′ {\displaystyle C_{c'}} denotes the end-capillary concentration of the gas (mL/dL), C v {\displaystyle C_{v}} denotes the mixed venous concentration of the gas (mL/dL), P I {\displaystyle P_{I}} denotes the inspired partial pressure of the gas (mmHg), and P A {\displaystyle P_{A}} denotes the alveolar partial pressure of the gas (mmHg) V A / Q {\displaystyle V_{A}/Q} denotes the ratio of alveolar ventilation to cardiac output For the purposes of utilizing the MIGET, the equations have been generalized for an inert gas (IG):
V A / Q = 8.63 × solubility × P V IG − P C ′ IG P A IG {\displaystyle V_{A}/Q=8.63\times {\ce {solubility}}\times {\frac {P_{V}{\ce {IG}}-P_{C'}{\ce {IG}}}{P_{A}{\ce {IG}}}}}
where:
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