Nitrogen washout/washin, helium dilution, and computed tomography in the assessment of end-expiratory lung volume
Critical Care volume 17, Article number: 453 (2013)
We read thoroughly the article published by Chiumello and colleagues  in a past issue of Critical Care, along with its corresponding erratum , and we believe that the authors have erroneously computed the limits of agreement on several occasions in their article. Indeed, according to the original article by Bland and Altman , which was cited by the authors in their Materials and methods section, the limits of agreement should be computed as bias ± 2 standard deviations.
Chiumello and colleagues  claimed that the average difference ± 1 standard deviation in the values of end-expiratory lung volume (EELV) measured with the Engström Carestation ventilator (GE Healthcare, Little Chalfont, Buckinghamshire, UK) and with the computed tomography scan amounted to 93 ± 143 mL and the limits of agreement to −50 to 236 mL. With 143 mL as the standard deviation of the bias, limits of agreement should hence become this: [93 − 2 × 143] − [93 + 2 × 143] mL = −193 to 379 mL. The graphical representation of these limits of agreement in the authors’ Figure one  is, however, correctly drawn in the interval (green lines) of −193 to 379 mL. So, there is a discrepancy between incorrect computation but a correct graphical representation of the limits of agreement for EELV with both techniques.
End-expiratory lung volume.
Chiumello D, Cressoni M, Chierichetti M, Tallarini F, Botticelli M, Berto V, Mietto C, Gattinoni L: Nitrogen washout/washin, helium dilution and computed tomography in the assessment of end expiratory lung volume. Crit Care 2008, 12: R150. 10.1186/cc7139
Chiumello D, Cressoni M, Chierichetti M, Tallarini F, Botticelli M, Berto V, Mietto C, Gattinoni L: Correction: Nitrogen washout/washin, helium dilution and computed tomography in the assessment of end expiratory lung volume. Crit Care 2009, 13: 405. 10.1186/cc7743
Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986, 327: 307-310. 10.1016/S0140-6736(86)90837-8
The authors declare that they have no competing interests.
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Richard, J.C., Guerin, C. Nitrogen washout/washin, helium dilution, and computed tomography in the assessment of end-expiratory lung volume. Crit Care 17, 453 (2013). https://doi.org/10.1186/cc13100