Arterial to end‐tidal carbon dioxide difference in children undergoing mechanical ventilation of the lungs during general anaesthesia

Onodi, C.; Bühler, Philipp; Thomas, Jörg; Schmitz, A.; Weiß, Markus

doi:10.1111/anae.13969

Cited by 22 publications

(16 citation statements)

References 12 publications

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“…1 Furthermore, negative arterial to endtidal carbon dioxide differences (ETCO 2 > PaCO 2 ) in children have been reported to erroneously lead to overestimation of ETCO 2 with subsequent risk of unrecognized hypocapnia. 21 In agreement with previous studies, the current animal model demonstrated a decrease in PtO 2 during hypocapnia. [9][10][11][12][13][14][15] The observed effect in the present study is even more convincing when the simultaneous increase in P a O 2 caused by hyperventilation is taken into account.…”

Section: Discussionsupporting

confidence: 93%

“…Hyperventilation with subsequent hypocapnia is an often‐observed accidental disturbance of physiological homeostasis during anesthesia and is sometimes even deliberately induced . Furthermore, negative arterial to endtidal carbon dioxide differences (ETCO 2 > PaCO 2 ) in children have been reported to erroneously lead to overestimation of ETCO 2 with subsequent risk of unrecognized hypocapnia …”

Section: Discussionmentioning

confidence: 99%

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Effects of moderate and severe hypocapnia on intracerebral perfusion and brain tissue oxygenation in piglets

Ringer

Clausen

Spielmann

et al. 2019

Pediatric Anesthesia

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Background Hypocapnia is a common alteration during anesthesia in neonates. Aim To investigate the effects of hypocapnia and hypocapnia combined with hypotension (HCT) on cerebral perfusion and tissue oxygenation in anesthetized piglets. Method Thirty anesthetized piglets were randomly allocated to groups: moderate hypocapnia (mHC), severe hypocapnia (sHC), and HCT. Cerebral monitoring comprised a tissue oxygen partial pressure and a laser Doppler probe inserted into the brain tissue as well as a near‐infrared spectroscopy (NIRS) sensor placed on the skin, measuring regional oxygen saturation. Hypocapnia was induced by hyperventilation (target PaCO2 mHC: 3.7‐4; sHC: 3.1‐3.3 kPa) and hypotension by blood withdrawal and nitroprusside infusion (mean blood pressure: 35‐38 mm Hg). Data were analyzed at baseline, during (Tr20, Tr40, Tr60) and after (Post20, Post40, Post60) treatment. Results Compared to baseline, tissue oxygen partial pressure decreased significantly and equally during all treatments (mean [SD] at baseline: mHC 35.7 [32.45]; sHC: 28.1 [20.24]; HCT 25.4 [10.3] and at Tr60: mHC: 29.9 [27.36]; sHC: 22.2 [18.37]; HCT: 18.4 [9.5] mm Hg). Decreased laser Doppler flow was detected with all treatments at Tr20 (mHC: 0.9 [0.18]; sHC: 0.88 [0.15]; HCT: 0.97 [0.13] proportion from baseline). Independently of group, regional oxygen saturation varied only after reverting and not during treatment. Blood lactate, pH, HCO3−, and PaO2 increased during treatment with no differences between groups. Conclusion This animal model revealed reduced cerebral blood flow and brain tissue oxygenation during hypocapnia without detectable changes in regional oxygen saturation as measured by NIRS. Changes occurred as early as during moderate hypocapnia.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Effects of moderate and severe hypocapnia on intracerebral perfusion and brain tissue oxygenation in piglets

Ringer

Clausen

Spielmann

et al. 2019

Pediatric Anesthesia

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“…Parameters provided by respiratory gas monitoring, such as respiratory gas flow, are required to monitor the saturation level of the patient (21,22). In a study that retrospectively investigated the differences in arterialend-tidal carbon dioxide in 799 pediatric patients undergoing general anesthesia with ventilation, it was determined that the decrease in PaCO2 was strongly related to the decrease in the PaCO2-ETCO2 difference (23). 29.5% and 32.7% of the nurses were found to have no knowledge about the function of the capnograph device and its effectiveness during the mechanical ventilator respectively.…”

Section: Discussionmentioning

confidence: 99%

Surgical nurses’ knowledge levels about hemodynamic monitoring

Özkan

Kulakaç

Şahin

et al. 2021

Anatolian Current Medical Journal

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Aim: This study was carried out to determine surgical nurses' knowledge levels about hemodynamic monitoring. Material and Method: The research was carried out in a descriptive design to determine the knowledge levels of surgical nurses related to hemodynamic monitoring. Nurses working in the surgical clinics of three hospitals in the Eastern Black Sea Region. 156 surgery nurses took part in the study. The data were collected through a questionnaire developed by the researchers. Percentage, mean, standard deviation, median, Kolmogorov-Smirnov test, t-test in independent groups, and variance analysis in multiple groups were used to evaluate the data in the research. Results: The mean score of the nurses' knowledge about hemodynamic monitoring was 65.3±7.9. There was a significant difference between nurses' receiving education on monitoring, gender, marital status, education level and the mean scores of their knowledge about hemodynamic monitoring (p<0.05). Conclusion:The study revealed that nurses had a lack of knowledge about hemodynamic monitoring, which was reflected in nursing care and practices. It is recommended that surgical nurses are provided detailed and regular training on hemodynamic monitoring methods and follow-up including nursing care.

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“…Capnography is considered the gold standard, both to determine correct placement of a de nitive airway and to guide ventilation during emergency care [9,10]. The assumed correlation between EtCO 2 and PaCO 2 has been known to be accompanied by a tension difference of CO 2 ranging anywhere between 0.26 and 0.66kPa (2 and 5 mmHg) in otherwise healthy individuals undergoing anesthesia [11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

End-tidal to arterial carbon dioxide gradient in traumatic brain injury after prehospital emergency anesthesia is associated with in-hospital mortality: a retrospective observational study

Doppmann

Meuli

Sollid

et al. 2021

Preprint

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Background Early definitive airway protection and normoventilation are key principles in the treatment of severe traumatic brain injury. These are currently guided by end tidal CO2 as a proxy for PaCO2. We assessed whether the difference between end tidal CO2 and PaCO2 at hospital admission is associated with in-hospital mortality.Method We conducted a retrospective observational cohort study of consecutive patients with traumatic brain injury who were intubated and transported by Helicopter Emergency Medical Services to a Level 1 trauma center between January 2014 and December 2019. We assessed the association between the CO2 gap—defined as the difference between end tidal CO2 and PaCO2—and in-hospital mortality using multivariate logistic regression models.Results 105 patients were included in this study. The mean ±SD CO2 gap at admission was 1.64 (± 1.09) kPa and significantly greater in non-survivors than survivors (2.26 ±1.30 kPa vs. 1.42 ±0.92 kPa, p<.001). The correlation between EtCO2 and PaCO2 at admission was low (Pearson's r=.287). The mean CO2 gap after 24 hours was only 0.64 ±0.82 kPa, and no longer significantly different between non-survivors and survivors. The multivariate logistic regression model showed that the CO2 gap was independently associated with increased mortality in this cohort and associated with a 2.7-fold increased mortality for every 1 kPa increase in the CO2 gap (OR 2.692, 95% CI 1.293 to 5.646, p=.009).Conclusions This study demonstrates that the difference between EtCO2 and PaCO2 is significantly associated with in-hospital mortality in patients with traumatic brain injury. EtCO2 was significantly lower than PaCO2, making it an unreliable proxy for PaCO2 when aiming for normocapnic ventilation. The higher-than-expected CO2 gap will lead to iatrogenic hypoventilation when normocapnic ventilation is aimed at, and might thereby increase in-hospital mortality.

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Arterial to end‐tidal carbon dioxide difference in children undergoing mechanical ventilation of the lungs during general anaesthesia

Cited by 22 publications

References 12 publications

Effects of moderate and severe hypocapnia on intracerebral perfusion and brain tissue oxygenation in piglets

Effects of moderate and severe hypocapnia on intracerebral perfusion and brain tissue oxygenation in piglets

Surgical nurses’ knowledge levels about hemodynamic monitoring

End-tidal to arterial carbon dioxide gradient in traumatic brain injury after prehospital emergency anesthesia is associated with in-hospital mortality: a retrospective observational study

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