Comparison of end-tidal and transcutaneous measures of carbon dioxide during general anaesthesia in severely obese adults

Griffin, Jamie Marincic; Terry, Boyd E.; Burton, R.K.; Ray, T.L.; Keller, Barbara Page; Landrum, Alice L.; Johnson, Joel O.; Tobias, Joseph D.

doi:10.1093/bja/aeg217

Cited by 43 publications

(35 citation statements)

References 15 publications

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“…fusion mismatching. 4,17 In this study, we focused on accuracy of P ETCO 2 measurement using a capnometry-type oxygen mask in subjects without a past medical history of pulmonary disease.…”

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

Evaluation of an Oxygen Mask-Based Capnometry Device in Subjects Extubated After Abdominal Surgery

et al. 2015

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BACKGROUND: For early detection of respiratory and hemodynamic changes during anesthesia, continuous end-tidal carbon dioxide concentration (P ETCO 2 ) is monitored by capnometry. However, the accuracy of CO 2 monitoring during spontaneous breathing in extubated patients remains undetermined. Therefore, we aimed to compare P ETCO 2 measured by capnometry using an oxygen mask with a carbon dioxide sampling port (capnometry-type oxygen mask) and P CO 2 in extubated subjects who had undergone abdominal surgery. Furthermore, we investigated whether spontaneous deep breathing affected dissociation between P aCO 2 and P ETCO 2 . METHODS: Adult post-abdominal surgery subjects admitted to the ICU were enrolled in this study. After extubation, oxygen was supplied at 6 L/min using the capnometry-type oxygen mask. After 30 min of oxygen supply, P aCO 2 blood gas analysis was performed, and P ETCO 2 was measured under resting and deep-breathing conditions. For both resting and deep-breathing conditions, the correlation between P aCO 2 and P ETCO 2 was analyzed. Furthermore, bias, precision, and limits of agreement were calculated using the Bland-Altman method. RESULTS: Twenty-five subjects (15 men, 10 women) with a mean age of 62 y (interquartile range of 57-76 y) and body mass index of 20 -24 kg/m 2 were studied. The correlation (r) between P aCO 2 and P ETCO 2 under resting and deep-breathing conditions was 0.50 and 0.56, respectively. Compared with P aCO 2 , the bias and limits of agreement were ؊12.6 (؊20.6 to ؊4.6) for resting P ETCO 2 and ؊9.1 (؊16.0 to ؊2.1) for deep-breathing P ETCO 2 . The association between P aCO 2 and deep-breathing P ETCO 2 was significantly smaller compared with resting P ETCO 2 (P ‫؍‬ .002). CONCLUSIONS: It is possible to measure the P ETCO 2 under varying breathing conditions with the capnometry-type oxygen mask in subjects receiving oxygen supplementation after extubation following upper abdominal surgery to determine whether they are properly ventilating. (ClinicalTrials.gov registration UMIN000011925.)

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“…fusion mismatching. 4,17 In this study, we focused on accuracy of P ETCO 2 measurement using a capnometry-type oxygen mask in subjects without a past medical history of pulmonary disease.…”

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

Evaluation of an Oxygen Mask-Based Capnometry Device in Subjects Extubated After Abdominal Surgery

et al. 2015

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“…In the present study, the TC-CO 2 continuously increased within 30 min after midazolam injection and decreased after flumazenil injection. Previous studies have reported a linear correlation between PaCO 2 and TC-CO 2 [6][7][8]. Bendjelid [9] reported that evaluation of PaCO 2 data on the basis of TC-CO 2 values was clinically acceptable, although the relationship between TC-CO 2 and PaCO 2 varies in patients breathing spontaneously in the intensive care unit.…”

Section: Discussionmentioning

confidence: 99%

“…However, a transcutaneous device is used for continuous noninvasive monitoring of PaCO 2 [6]. Previous studies have demonstrated a linear correlation between PaCO 2 and transcutaneous CO 2 (TC-CO 2 ) [7][8][9]. The results of TC-CO 2 monitoring are independent of air leakage [10].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Transcutaneous and End-Tidal Carbon Dioxide During Intravenous Sedation in Volunteers

Satoh¹

2014

J Anesth Clin Res

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Objective: During intravenous sedation, end-tidal carbon dioxide (ETCO 2 ) is usually measured with a nasal cannula or mouth-nose cannula. We compared the measurement accuracy of ETCO 2 between these two devices and TC-CO 2 and assessed which device is more useful during intravenous sedation in volunteers.Methods: Eight male volunteers aged 25 to 35 years were evaluated in this single-institution blinded observational trial. After they lay quietly for 5 min without supplemental oxygen, the volunteers received supplemental oxygen by means of each device at a flow rate of 3 L/min for 15 min. Next, midazolam (0.05 mg/kg) was intravenously injected, flumazenil (20 mg) was injected 30 min later, and the ETCO 2 and TC-CO 2 waveform were recorded. Results:The differences between ETCO 2 and TC-CO 2 significantly increased after midazolam injection and decreased after flumazenil injection. The difference between ETCO 2 and TC-CO 2 using the nasal cannula was greater than that using the mouth-nose cannula. The mean difference between TC-CO 2 and ETCO 2 ranged from 3 to 9 mmHg after midazolam injection using a nasal mask, and the mean difference ranged from 3 to 6 mmHg after midazolam injection using a mouth-nose cannula. Conclusions:The difference between ETCO 2 and TC-CO 2 against TC-CO 2 was within the clinically acceptable range. Both the nasal and mouth-nose cannula were useful for ETCO 2 measurement with supplemental oxygen by means of each device at flow rate of 3 L/min during intravenous sedation in volunteers.

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“…This is the original idea when we carried out the experiment. We synthesized PetCO 2 local production of carbon dioxide in the tissue, which leads to falsely high measurements [14]. On the contrary, PetCO 2 measurement was always underestimated compared with PCO 2 because gas from lung units that were ventilated but not perfused (alveolar dead space or high ventilation-perfusion ratio units) contains little or no carbon dioxide.…”

Section: Discussionmentioning

confidence: 99%

“…However, according to the early studies, neither PetCO 2 nor PtcCO 2 monitoring has provided accurate estimates of PaCO 2 [13][14][15] …”

Section: Introductionmentioning

confidence: 99%

Combined Use of Transcutaneous and End-Tidal Measures of Carbon Dioxide to Predict PCO2 during General Anaesthesia in Adults

Yi¹

2013

J Clin Exp Cardiolog

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Comparison of end-tidal and transcutaneous measures of carbon dioxide during general anaesthesia in severely obese adults

Abstract: Transcutaneous carbon dioxide monitoring provides a better estimate of Pa(CO(2)) than FE'(CO(2)) in patients with severe obesity.

Cited by 43 publications

References 15 publications

Evaluation of an Oxygen Mask-Based Capnometry Device in Subjects Extubated After Abdominal Surgery

Evaluation of an Oxygen Mask-Based Capnometry Device in Subjects Extubated After Abdominal Surgery

Evaluation of Transcutaneous and End-Tidal Carbon Dioxide During Intravenous Sedation in Volunteers

Combined Use of Transcutaneous and End-Tidal Measures of Carbon Dioxide to Predict PCO2 during General Anaesthesia in Adults

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