Comparison of transcutaneous and endtidal CO₂‐monitoring for rigid bronchoscopy during high‐frequency jet ventilation

Abstract

Endtidal capnography offers accurate respiratory monitoring of HFJV. Transcutaneous monitoring showed a good correlation to ABG only during steady-state conditions. For the dynamic phase the accuracy was significantly lower. Thus, we cannot recommend transcutaneous respiratory monitoring for the specific indication of rigid bronchoscopy using HFJV.

High-frequency jet ventilation in interventional bronchoscopy: factors with predictive value on high-frequency jet ventilation complications

“…raphy during HFJV has been considered a reliable and sufficiently accurate method for monitoring ventilatory efficiency [10,11,15,16]. Incidence of hypoxemia in our study was higher than that observed by Hautmann et al [7].…”

Hyperventilation and amplified blood pressure response: is there a link?

“…In diagnosing hypocapnia, the ETPCO 2 cutoff 30 mmHg is accepted by some authors while a 25 mmHg cutoff is preferred by others. 9,13,24,25 The inconsistency in defining hypocapnia stems from the observations that the clinical consequences of HV are not dependent only on CO 2 levels, but also on the competence of the alkaline buffering systems, neuronal reactivity, integrity of the Ca 2 þ /Mg 2 þ balance in smooth muscle, and the efficacy of habituation. 40 Furthermore, symptoms that are typically associated with HV such as paresthesias of fingers or face, lightheadedness, dizziness, palpitations, tachycardia, headache, fatigue, heaviness of arms or legs, tremor of hands, hot or cold sensations, chest pain, nausea, tinnitus, visual blurring are not specific for hypocapnia and may be encountered in a variety of other disease states.…”

“…In diagnosing HV, a reading below the ETPCO 2 cutoff of 30 mmHg is accepted by some authors while a 25 mmHg cutoff is preferred by others because of the alleged poor discriminatory power of the 30 mmHg cutoff. 9,13,24,25 In the present study, HV was diagnosed when end-tidal pressure of CO 2 o30 mmHg were recorded consecutively for X10 min ( Figure 1). Symptoms of HV were recorded when patients volunteered them on their own initiative, but not in response to direct questioning, as follows: paresthesias of fingers or the face, palpitations, hot or cold sensations, lightheadedness, dizziness.…”

“…A 24-h ambulatory BP monitoring is feasible, however, because of the slow response time of the electrodes and reflex vasoconstriction of skin vessels transcutaneous blood gas measurements for HV are not reliable. 8,9 The Hyperventilation Provocation Test consists of voluntary HV followed by monitoring the end tidal pressure of CO 2 (ETPCO 2 ) in the exhaled air in order to determine the time to recovery from induced hypocapnia. The low specificity of the Hyperventilation Provocation Test has been criticized.…”

Anesthesia for interventional pulmonology procedures: a review of advanced diagnostic and therapeutic bronchoscopy

“…The end-tidal CO 2 after brief periods of HFJV interruption can be used to estimate partial pressure of CO 2 along with transcutaneous CO 2 monitoring to guide ventilator parameters. 124 Although some patients will require an arterial cannula to monitor arterial gases, the adequate use of capnography may reduce unnecessary arterial blood gas sampling. 125 Recommendations to prevent barotrauma include maintaining a driving pressure around 1.5 bar (approximately 20 PSI) and limiting inspiration duration to 30-40% of the respiratory cycle.…”