Noninvasive Carbon Dioxide Monitoring

Mc, Stock

doi:10.1016/s0749-0704(18)30479-2

Cited by 32 publications

(12 citation statements)

References 29 publications

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“…Non-invasive measurement of PaCO 2 relies basically on 2 different techniques: the measurement of end-tidal CO 2 (ETCO 2 ) in expired air, and transcutaneous measurement of carbon dioxide (TcPCO 2 ) [4]. Although simple, and widely used by anesthetists, ETCO 2 is mainly useful to document trends in PaCO 2 : the correlation between PaCO 2 and ETCO 2 depends on the ventilatory mode and the physiologic dead space (ETCO 2 = PaCO 2 (1 -V D /V T ); V D = physiological dead space; V T = tidal volume) which can both be significantly altered in subjects with a cardiac or respiratory pathology; ETCO 2 is thus a poor predictor of PaCO 2 [5,6]. Transcutaneous measurement of TcPCO 2 , although widely used and considered reliable in neonatology, has yielded conflicting results in adults [5,7,8]; however, the recent development of non-invasive ventilation in an acute or chronic setting has caused a renewed interest in this technique, with recently published encouraging results [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Non-Invasive (Transcutaneous) Monitoring of PCO2 (TcPCO2) in Older Adults

Janssens¹,

Laszlo²,

Uldry³

et al. 2005

Gerontology

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Background: Transcutaneous measurements of arterial blood gases (ABG) may decrease the need for repeated arterial puncture in older patients treated for acute cardiac or pulmonary disorders. However, age-related changes in skin perfusion, metabolism, or thickness may alter the validity of the technique. Objective: To analyse the agreement between transcutaneous and arterial measurement of PaO₂ and PaCO₂ in older adults. Design: Prospective descriptive study performed in the intermediate-care unit of a geriatric university hospital and a pulmonary rehabilitation centre. Methods: 40 patients, aged 82.5 ± 8 years (66–97), hemodynamically stable, without vasopressor treatment, underwent simultaneous measurement of arterial blood gases (ABG) and transcutaneous CO₂ (TcPCO₂) and O₂ (TcPO₂) with a Radiometer TINA TCM3^® capnograph, and a probe T° set at 43°C. Results: Correlation between PaCO₂ and TcPCO₂ was high (r² = 0.86) with a low bias (–0.1 mm Hg) and limits of agreement quite compatible with clinical use: (8.3; –8.5 mm Hg). The probe was well tolerated without any cutaneous lesion even after prolonged recordings (up to 8 h). Conversely, although TcPO₂ and PaO₂ were significantly correlated, the variability around the regression line precludes the use of transcutaneous measurements for monitoring PaO₂in a clinical setting. Conclusion: In older subjects, TcPCO₂ (but not TcPO₂) measurements are reliable when repeated assessment of ABG is warranted.

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Section: Introductionmentioning

confidence: 99%

Non-Invasive (Transcutaneous) Monitoring of PCO2 (TcPCO2) in Older Adults

Janssens¹,

Laszlo²,

Uldry³

et al. 2005

Gerontology

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“…The calibration and analysis time required for mass spectrometry is significantly longer than for infrared techniques. Infrared systems respond to changes in approximately 100 msec, whereas mass spectrometers take from 45 seconds to 5 minutes to respond [155]. Although costs vary widely, mass spectrometers are generally far more expensive and are most frequently purchased to be the central component of a carbon dioxide monitoring system.…”

Section: Indications For Use Transcutaneous Monitors Havementioning

confidence: 99%

“…The plateau level is determined by the mean alveolar PC02, which is in equilibration with pulmonary artery Pco2 (PA02). The end-alveolar plateau level of Pco2 measured during the last 20% of exhalation is the end-tidal Pco2 [155]. In normal individuals at rest, the difference between end-tidal Pco2 and arterial Pco2 is plus or minus 1.5 mm Hg.…”

Section: Indications For Use Transcutaneous Monitors Havementioning

confidence: 99%

“…An irregular respiratory pattern or large increases in dead space can also distort the plateau phase. Visual inspection of traces can detect situations where algorithms are prone to produce errors [155].…”

Section: Indications For Use Transcutaneous Monitors Havementioning

confidence: 99%

“…Although theoretically attractive, use of end-tidal carbon dioxide measurements to evaluate changes in ventilation perfusion mismatch has failed to yield clinical benefits [162]. Capnography has been helpful in the operating room in detecting air and pulmonary embolism as well as malignant hyperthermia [155,157]. In these situations, the capnograph does not provide a diagnosis.…”

Section: Indications For Use Transcutaneous Monitors Havementioning

confidence: 99%

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Routine Monitoring of Critically I11 Patients

Curley

Smyrnios

1990

J Intensive Care Med

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The explosion in computer use and technology during the past several decades has dramatically changed criti cal care. All vital signs can now be monitored accu rately, noninvasively, and continuously. We examined the predominantly noninvasive methods of monitor ing temperature, arterial blood pressure, heart rate and rhythm, respiratory mechanics, and gas exchange that can be used continuously on almost every patient in the intensive care unit. We conclude that temperature should be measured either intermittently with a rectal thermometer or continuously with a rectal, bladder, or great vessel thermocouple or thermistor probe. Arterial pressure should be measured either intermittently with a sphygmomanometer and cuff or continuously with an indwelling arterial catheter, except in specific situa tions when automated indirect monitoring may be use ful. Electrocardiographic rhythm monitoring has been clearly shown to improve prognosis in patients after acute myocardial infarction and should be universal in all intensive care units. Ischemia monitoring may prove beneficial, but its role has not been clearly defined. Re spiratory inductance plethysmography is effective in measuring respiratory rate, tidal volume, and breathing pattern. Pulse oximetry is useful in detecting occult hy poxemia. It should be continuous on most patients. Transcutaneous oxygen and carbon dioxide measure ment has a limited role in monitoring gas exchange and perfusion. Capnography also has a limited role in the intensive care unit but is more helpful in the operating room.

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Infrared end‐tidal CO₂ measurement does not accurately predict arterial CO₂ values or end‐tidal to arterial P, gradients in rabbits with lung injury

Hopper

Nystrom

Deming

et al. 1994

Pediatric Pulmonology

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End-tidal PCO2 (PETCO2) measurements from two commercially available neonatal infrared capnometers with different sampling systems and a mass spectrometer were compared with arterial PCO2 (PaCO2) to determine whether the former could predict the latter in mechanically ventilated rabbits with and without lung injury. The effects of tidal volume, ventilator frequency and type of lung injury on the gradient between PETCO2 and PaCO2 (delta P(a-ET)CO2) were evaluated. Twenty rabbits were studied: 10 without lung injury, 5 with saline lavage and 5 with lung injury by meconium instillation. Paired measurements of PETCO2 by two infrared capnometers and a mass spectrometer were compared to PaCO2. In the rabbits without lung injury, the values from the infrared capnometers and mass spectrometer correlated strongly with PaCO2 (r > or = 0.91) despite differences in the slopes of the linear regression between PETCO2 and PaCO2 and in delta P(a-ET)CO2 (P < 0.05). Values from the mainstream IR-capnometer more closely approximated the line of identity than the regression between the sidestream IR-capnometer values or the mass spectrometer and PaCO2, but tended to overestimate PaCO2. The delta P(a-ET)CO2 was similar at all tidal volumes and ventilator frequencies, regardless of capnometer type. In the rabbits with induced lung injury, while there was a positive correlation between the slopes of the regression between PETCO2 and PaCO2 for both capnometers (r > or = 0.70), none of the regression slopes approximated the line of identity. The delta P(a-ET)CO2 was greater in rabbits with injured than noninjured lungs (P < 0.05). The delta P(a-ET)CO2 was similar among capnometers regardless of tidal volume, ventilator frequency, or type of lung injury. The 95% confidence interval of plots PaCO2 against PETCO2 was large for rabbits with injured and noninjured lungs.(ABSTRACT TRUNCATED AT 250 WORDS)

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Noninvasive Carbon Dioxide Monitoring

Cited by 32 publications

References 29 publications

Non-Invasive (Transcutaneous) Monitoring of PCO<sub>2</sub> (TcPCO<sub>2</sub>) in Older Adults

Non-Invasive (Transcutaneous) Monitoring of PCO<sub>2</sub> (TcPCO<sub>2</sub>) in Older Adults

Routine Monitoring of Critically I11 Patients

Infrared end‐tidal CO₂ measurement does not accurately predict arterial CO₂ values or end‐tidal to arterial P, gradients in rabbits with lung injury

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Noninvasive Carbon Dioxide Monitoring

Cited by 32 publications

References 29 publications

Non-Invasive (Transcutaneous) Monitoring of PCO<sub>2</sub> (TcPCO<sub>2</sub>) in Older Adults

Non-Invasive (Transcutaneous) Monitoring of PCO<sub>2</sub> (TcPCO<sub>2</sub>) in Older Adults

Routine Monitoring of Critically I11 Patients

Infrared end‐tidal CO2 measurement does not accurately predict arterial CO2 values or end‐tidal to arterial P, gradients in rabbits with lung injury

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Infrared end‐tidal CO₂ measurement does not accurately predict arterial CO₂ values or end‐tidal to arterial P, gradients in rabbits with lung injury