Accuracy evaluation of mainstream and sidestream end-tidal carbon dioxide monitoring during noninvasive ventilation: a randomized crossover trial (MASCAT-NIV trial)

Sakuraya, Masaaki; Douno, Eri; Iwata, Wakana; Takaba, Akihiro; Hadama, Kosuke; Kawamura, Natsuki; Maezawa, Toshinori; Iwamoto, Kaoru; Yoshino, Yuya

doi:10.1186/s40560-022-00603-w

Cited by 6 publications

(5 citation statements)

References 31 publications

(28 reference statements)

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“…The authors concluded that the results of previous studies monitoring ETCO 2 during NIV were mixed likely due to physiological issues and shortcomings of exhalation sample collection. (12)…”

Section: Discussionmentioning

confidence: 99%

“…(8) There is some debate surrounding the correlation of ETCO2 to PaCO2, but several studies have found good correlation in healthy patients and patients with compromised pulmonary function who are spontaneously breathing. (9)(10)(11)(12) Capnography has been shown to be a valuable screening tool for mortality predictions in patients with sepsis. (13,14) Also, in penetrating trauma patients, capnography measurements correlate with serum lactate levels (an indicator of tissue hypoxia and shock) and can predict the odds of the patient requiring operative intervention.…”

Section: Introductionmentioning

confidence: 99%

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Integration of Capnography and Continuous Positive Airway Pressure (CPAP) in the Prehospital Setting

Sethi,

Hobbs,

Hubbard

et al. 2023

Preprint

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BACKGROUND: Capnography is one of the most important respiratory monitoring tools used in EMS because changes to end-tidal CO2 (ETCO2) generally precede blood oxygen desaturation, and waveform morphology can be used to assess bronchial patency. Many of capnography's indications overlap with those of continuous positive airway pressure (CPAP) therapy. However, there are currently no convenient methods to administer CPAP while using capnography, and no peer-reviewed studies have examined combining the two technologies in the prehospital setting. METHODS & FINDINGS: Two types of capnography sampler were used to investigate how ETCO2, capnogram shape, and respiration rate (RR) are affected by applying a CPAP mask both with and without oxygen flowing. A traditional nasal-oral cannula (NC) sampler, as well as a novel sampler that does not break the seal between the CPAP mask and the patient's face (called the CPAP-Capnography Adapter, or CCA), were evaluated on a Human Patient Simulator (HPS). No significant differences between the NC and CCA were found for ETCO2 and RR percent error. Placement of a CPAP mask without turning on O2 increased ETCO2. During CPAP therapy, the two samplers maintained their RR measurement accuracy, but ETCO2 values were significantly reduced and the capnogram depicted an increased 𝛽-angle with severe blunting of the inspiratory downstroke. CONCLUSIONS: The HPS had set-point ETCO2 and PaCO2 values, indicating that the local CO2 concentration at the nares was diluted during CPAP and no longer accurately reflected the simulated subject's breathing. The compromise in waveform morphology could be overcome by further research into interpreting capnogram differences during CPAP between healthy patients and those with respiratory pathologies. However, at this time, our results show that ETCO2 values and capnogram shape should be interpreted with caution during CPAP.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Integration of Capnography and Continuous Positive Airway Pressure (CPAP) in the Prehospital Setting

Sethi,

Hobbs,

Hubbard

et al. 2023

Preprint

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“…This is in obvious contrast to mainstream capnography, where the gas mixture is analyzed directly in the circuit. Previous studies in subjects during supine craniotomy and cardiac surgery in the operating room, during noninvasive ventilation in the ICU, and in spontaneously breathing subjects in the emergency room have shown more variable and less accurate etCO 2 measurements with sidestream capnography [ 17 , 18 , 22 , 23 ]. Similar findings come from studies in pediatric populations, especially during periods with higher respiratory rates [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Closed–Loop ventilation using sidestream versus mainstream capnography for automated adjustments of minute ventilation—A randomized clinical trial in cardiac surgery patients

Nijbroek,

Roozeman,

Ettayeby

et al. 2023

PLoS ONE

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Background INTELLiVENT–Adaptive Support Ventilation (ASV) is a closed–loop ventilation mode that uses capnography to adjust tidal volume (VT) and respiratory rate according to a user–set end–tidal CO2 (etCO2) target range. We compared sidestream versus mainstream capnography with this ventilation mode with respect to the quality of breathing in patients after cardiac surgery. Methods Single–center, single–blinded, non–inferiority, randomized clinical trial in adult patients scheduled for elective cardiac surgery that were expected to receive at least two hours of postoperative ventilation in the ICU. Patients were randomized 1:1 to closed–loop ventilation with sidestream or mainstream capnography. Each breath was classified into a zone based on the measured VT, maximum airway pressure, etCO2 and pulse oximetry. The primary outcome was the proportion of breaths spent in a predefined ‘optimal’ zone of ventilation during the first three hours of postoperative ventilation, with a non–inferiority margin for the difference in the proportions set at –20%. Secondary endpoints included the proportion of breaths in predefined ‘acceptable’ and ‘critical’ zones of ventilation, and the proportion of breaths with hypoxemia. Results Of 80 randomized subjects, 78 were included in the intention–to–treat analysis. We could not confirm the non–inferiority of closed–loop ventilation using sidestream with respect to the proportion of breaths in the ‘optimal’ zone (mean ratio 0.87 [0.77 to ∞]; P = 0.116 for non–inferiority). The proportion of breaths with hypoxemia was higher in the sidestream capnography group versus the mainstream capnography group. Conclusions We could not confirm that INTELLiVENT–ASV using sidestream capnography is non–inferior to INTELLiVENT–ASV using mainstream capnography with respect to the quality of breathing in subjects receiving postoperative ventilation after cardiac surgery. Trial registration NCT04599491 (clinicaltrials.gov).

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“…It is used for many applications like cardiopulmonary resuscitation, airway assessment, sedation, and analgesia [47]. It can be useful for the early recognition of potential breathing complications and the recognition of respiratory compromise or failure [44,48], allowing for prompt diagnosis and, consequently, a timely intervention or correction.…”

Section: End-tidal Monitoringmentioning

confidence: 99%

Recent Technologies for Transcutaneous Oxygen and Carbon Dioxide Monitoring

Bernasconi,

Angelucci,

De Cesari

et al. 2024

Diagnostics

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The measurement of partial pressures of oxygen (O2) and carbon dioxide (CO2) is fundamental for evaluating a patient’s conditions in clinical practice. There are many ways to retrieve O2/CO2 partial pressures and concentrations. Arterial blood gas (ABG) analysis is the gold standard technique for such a purpose, but it is invasive, intermittent, and potentially painful. Among all the alternative methods for gas monitoring, non-invasive transcutaneous O2 and CO2 monitoring has been emerging since the 1970s, being able to overcome the main drawbacks of ABG analysis. Clark and Severinghaus electrodes enabled the breakthrough for transcutaneous O2 and CO2 monitoring, respectively, and in the last twenty years, many innovations have been introduced as alternatives to overcome their limitations. This review reports the most recent solutions for transcutaneous O2 and CO2 monitoring, with a particular consideration for wearable measurement systems. Luminescence-based electronic paramagnetic resonance and photoacoustic sensors are investigated. Optical sensors appear to be the most promising, giving fast and accurate measurements without the need for frequent calibrations and being suitable for integration into wearable measurement systems.

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Accuracy evaluation of mainstream and sidestream end-tidal carbon dioxide monitoring during noninvasive ventilation: a randomized crossover trial (MASCAT-NIV trial)

Cited by 6 publications

References 31 publications

Integration of Capnography and Continuous Positive Airway Pressure (CPAP) in the Prehospital Setting

Integration of Capnography and Continuous Positive Airway Pressure (CPAP) in the Prehospital Setting

Closed–Loop ventilation using sidestream versus mainstream capnography for automated adjustments of minute ventilation—A randomized clinical trial in cardiac surgery patients

Recent Technologies for Transcutaneous Oxygen and Carbon Dioxide Monitoring

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