Monitoring Carbon Dioxide Tension and Arterial Oxygen Saturation by a Single Earlobe Sensor in Patients With Critical Illness or Sleep Apnea

Senn, Oliver; Clarenbach, Christian F.; Kaplan, Vladimír; Maggiorini, Marco; Bloch, Konrad E.

doi:10.1378/chest.128.3.1291

Cited by 82 publications

(61 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, when we look at the studies that have evaluated subjects with high levels of P aCO 2 , conflicting find-ings are continuously observed. Some authors suggest that at high P aCO 2 values, larger differences between P tcCO 2 and P aCO 2 are observed.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Transcutaneous Carbon Dioxide Monitoring in Subjects With Acute Respiratory Failure and Severe Hypercapnia

et al. 2016

View full text Add to dashboard Cite

BACKGROUND: Transcutaneous carbon dioxide (P tcCO 2 ) monitoring is being used increasingly to assess acute respiratory failure. However, there are conflicting findings concerning its reliability when evaluating patients with high levels of P aCO 2 . Our study evaluates the accuracy of this method in subjects with respiratory failure according to the severity of hypercapnia. METHODS: We included subjects with respiratory failure, admitted to a respiratory intermediate care unit, who required arterial blood gas analysis. Simultaneously, P tcCO 2 was measured using a digital monitor. Relations between P aCO 2 and P tcCO 2 were assessed by the Pearson correlation coefficient. BlandAltman analysis was used to test data dispersion, and an analysis of variance test was used to compare the differences between P aCO 2 and the corresponding P tcCO 2 at different levels (level 1, <50 mm Hg; level 2, 50 -60 mm Hg; level 3, >60 mm Hg). RESULTS: Eighty-one subjects were analyzed. The main diagnosis was COPD exacerbation (45%). P tcCO 2 correlated well with P aCO 2 (r2 ‫؍‬ 0.93, P < .001). Bland-Altman analysis showed a mean P aCO 2 ؊ P tcCO 2 difference of 4.9 ؎ 4.4 with 95% limits of agreement ranging from ؊3.6 to 13.4. The difference between variables increased in line with P aCO 2 severity: level 1, 1.7 ؎ 3.2 mm Hg; level 2, 3.7 ؎ 2.8; level 3, 6.8 ؎ 4.7 (analysis of variance, P < .001). CONCLUSIONS: Our study showed an acceptable agreement of P tcCO 2 monitoring with arterial blood gas analysis. However, we should consider that P tcCO 2 underestimates P aCO 2 levels, and its accuracy depends on the level of hypercapnia, so this method would not be suitable for acute patients with severe hypercapnia.

show abstract

Section: Introductionmentioning

confidence: 99%

“…Some authors suggest that at high P aCO 2 values, larger differences between P tcCO 2 and P aCO 2 are observed. 9,13 In contrast, other studies [6][7][8] consider that the agreement between the 2 methods is independent of the level of P aCO 2 .…”

Section: Introductionmentioning

confidence: 99%

Transcutaneous Carbon Dioxide Monitoring in Subjects With Acute Respiratory Failure and Severe Hypercapnia

et al. 2016

View full text Add to dashboard Cite

show abstract

“…4,[13][14][15][16][17][18] The reasons for the observed differences between P aCO 2 and P tcCO 2 have previously been reviewed. 19 However, we would attest that the aim of continuous CO 2 measurement during extended sleep monitoring is to detect sleep-related changes that suggest the presence or adequate control of hypoventilation, rather than as a direct measure of P aCO 2 per se (ie, monitoring changes during sleep, rather than measuring absolute values), so noninvasive devices that can detect change over an extended monitoring period with sufficient accuracy and minimal artifactual drift have substantial clinical utility.…”

Section: Discussionmentioning

confidence: 99%

Transcutaneous Measurement of Carbon Dioxide Tension During Extended Monitoring: Evaluation of Accuracy and Stability, and an Algorithm for Correcting Calibration Drift

et al. 2011

View full text Add to dashboard Cite

BACKGROUND: When polysomnography is indicated in a patient with a presumed sleep disorder, continuous monitoring of arterial carbon dioxide tension (P aCO 2 ) is desirable, especially if nocturnal hypoventilation is suspected. Transcutaneous CO 2 monitors (P tcCO 2 ) provide a noninvasive correlate of P aCO 2 , but their accuracy and stability over extended monitoring have been considered inadequate for the diagnosis of hypoventilation. We examined the stability and accuracy of P tcCO 2 measurements and the performance of a previously described linear interpolation technique designed to correct for calibration drift. METHODS: We compared the P tcCO 2 values from 2 TINA TCM-3 monitors to P aCO 2 values from arterial blood samples obtained at the beginning, every 15 min of the first hour, and then hourly over 8 hours of monitoring in 6 hemodynamically stable, male, intensive care patients (mean age 46 ؎ 17 y). RESULTS: Time had a significant (P ‫؍‬ .002) linear effect on the P tcCO 2 -P aCO 2 difference, suggesting calibration drift over the monitoring period. We found no differences between monitor type or interaction between time and monitor type. For the 2 monitors the uncorrected bias was 3.6 mm Hg and the limits of agreement were ؊5.1 to 12.3 mm Hg. Our linear interpolation algorithm improved the bias and limits of agreement to 0.4 and ؊5.5 to 6.4 mm Hg, respectively. CONCLUSIONS: Following stabilization and correction for both offset and drift, P tcCO 2 tracks P aCO 2 with minimal residual bias over 8 hours of monitoring. Should future research confirm these findings, then interpolated P tcCO 2 may have an increased role in detecting sleep hypoventilation and assessing the efficacy of treatment.

show abstract

“…The measurement of transcutaneous P CO 2 (P tcCO 2 ) has been examined in critically ill [14][15][16] or ventilated adults 17,18 and newborns, 19 as well as during bronchoscopy 20 or interhospital ground transport. The aim of our study was to compare P tcCO 2 with P capCO 2 in hypercapnic subjects during the night.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Transcutaneous and Capillary Measurement of P_CO₂in Hypercapnic Subjects

et al. 2015

View full text Add to dashboard Cite

BACKGROUND: Measurement of P CO 2 is vital in determining effective alveolar ventilation. However, obtaining capillary P CO 2 by a skin prick of the earlobe is painful, and nocturnal measurements disturb sleep. End-expiratory measurement of P CO 2 is also well established, but there is a low precision in predicting arterial or capillary CO 2 . The purpose of the study was to evaluate nocturnal measurement of noninvasive, transcutaneous P CO 2 (P tcCO 2 ) measurement in hypercapnic subjects. METHODS: In this prospective study, 31 subjects with chronic hypercapnic failure-in a stable phase of the underlying disease-and a control group of 12 healthy volunteers were included. Transcutaneous measurements were taken by the Tosca sensor (Radiometer, Copenhagen, Denmark) over a period of at least 6 h during the night. A capillary blood gas was measured at midnight and 4:00 am. RESULTS: The mean nocturnal capillary P CO 2 (P capCO 2 ) of subjects was 50.6 ؎ 10.2 mm Hg. In the 31 subjects with known hypercapnic respiratory failure, the correlation between P tcCO 2 and P capCO 2 at midnight was 0.86 and at 4:00 am r ‫؍‬ 0.80. The bias of the hypercapnic subjects was d ‫؍‬ ؉ 4.5 with a limit(s) of agreement of 2 SD ‫؍‬ 13.0. The process of blood sampling caused no significant change in P tcCO 2 . CONCLUSIONS: Our study evaluated transcutaneous capnography as a continuous nocturnal measurement in hypercapnic subjects. We found a good agreement between the methods. Because CO 2 is not constant in patients with respiratory failure, but instead fluctuates, we would recommend the continuous transcutaneous measurement of P CO 2 as our method of choice in the diagnosis of nocturnal hypercapnia.

show abstract

Monitoring Carbon Dioxide Tension and Arterial Oxygen Saturation by a Single Earlobe Sensor in Patients With Critical Illness or Sleep Apnea

Cited by 82 publications

References 19 publications

Transcutaneous Carbon Dioxide Monitoring in Subjects With Acute Respiratory Failure and Severe Hypercapnia

Transcutaneous Carbon Dioxide Monitoring in Subjects With Acute Respiratory Failure and Severe Hypercapnia

Transcutaneous Measurement of Carbon Dioxide Tension During Extended Monitoring: Evaluation of Accuracy and Stability, and an Algorithm for Correcting Calibration Drift

Comparison of Transcutaneous and Capillary Measurement of P_CO₂in Hypercapnic Subjects

Contact Info

Product

Resources

About

Monitoring Carbon Dioxide Tension and Arterial Oxygen Saturation by a Single Earlobe Sensor in Patients With Critical Illness or Sleep Apnea

Cited by 82 publications

References 19 publications

Transcutaneous Carbon Dioxide Monitoring in Subjects With Acute Respiratory Failure and Severe Hypercapnia

Transcutaneous Carbon Dioxide Monitoring in Subjects With Acute Respiratory Failure and Severe Hypercapnia

Transcutaneous Measurement of Carbon Dioxide Tension During Extended Monitoring: Evaluation of Accuracy and Stability, and an Algorithm for Correcting Calibration Drift

Comparison of Transcutaneous and Capillary Measurement of PCO2in Hypercapnic Subjects

Contact Info

Product

Resources

About

Comparison of Transcutaneous and Capillary Measurement of P_CO₂in Hypercapnic Subjects