The Application of Transcutaneous CO2 Pressure Monitoring in the Anesthesia of Obese Patients Undergoing Laparoscopic Bariatric Surgery

Liu, Shijiang; Sun, Jianfang; Chen, Xing; Yu, Yanting; Li, Xuan; Liu, Cunming

doi:10.1371/journal.pone.0091563

Cited by 15 publications

(14 citation statements)

References 23 publications

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“…Although the accuracy of PtcCO 2 has been a subject of debate, PtcCO 2 monitors have become easier to use in clinical practice [12] and have shown acceptable agreement with PaCO 2 in a geriatric population [13], in patients with acute dyspnoea [14], patients with ALS [15], patients with severe obesity [16] and during cardiopulmonary exercise testing [17]. Conversely, studies conducted at emergency departments [18,19], during surgery [20,21] and in ICUs [20] report conflicting or poorer results, indicating that validity of PtcCO 2 may depend on the population studied and the clinical setting in which it is used. The small number of studies conducted in patients with CRF treated with NIV have either used older PtcCO 2 devices [22,23] or included a limited number of patients [24e26].…”

Section: Introductionmentioning

confidence: 99%

Validity of transcutaneous PCO 2 in monitoring chronic hypoventilation treated with non-invasive ventilation

Aarrestad

Tollefsen

Kleiven

et al. 2016

Respiratory Medicine

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Section: Introductionmentioning

confidence: 99%

Validity of transcutaneous PCO 2 in monitoring chronic hypoventilation treated with non-invasive ventilation

Aarrestad

Tollefsen

Kleiven

et al. 2016

Respiratory Medicine

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“…In adults, PtcCO 2 has shown conflicting results 29,30 and may be affected by hypotension, peripheral perfusion disturbances and the use of vasoconstrictors 31,32 . Transcutaneous PCO 2 appears to be a more accurate method compared with PETCO 2 , but its accuracy might deteriorate with extreme PaCO 2 values and is also affected by V/Q mismatch 23,33,34 …”

Section: Discussionmentioning

confidence: 99%

Evaluating a novel formula for noninvasive estimation of arterial carbon dioxide during post‐resuscitation care

Rentola

Skrifvars

Heinonen

et al. 2020

Acta Anaesthesiol Scand

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Background Controlling arterial carbon dioxide is paramount in mechanically ventilated patients, and an accurate and continuous noninvasive monitoring method would optimize management in dynamic situations. In this study, we validated and further refined formulas for estimating partial pressure of carbon dioxide with respiratory gas and pulse oximetry data in mechanically ventilated cardiac arrest patients. Methods A total of 4741 data sets were collected retrospectively from 233 resuscitated patients undergoing therapeutic hypothermia. The original formula used to analyze the data is PaCO2‐est1 = PETCO2 + k[(PIO2 − PETCO2) − PaO2]. To achieve better accuracy, we further modified the formula to PaCO2‐est2 = k1*PETCO2 + k2*(PIO2 − PETCO2) + k3*(100‐SpO2). The coefficients were determined by identifying the minimal difference between the measured and calculated arterial carbon dioxide values in a development set. The accuracy of these two methods was compared with the estimation of the partial pressure of carbon dioxide using end‐tidal carbon dioxide. Results With PaCO2‐est1, the mean difference between the partial pressure of carbon dioxide, and the estimated carbon dioxide was 0.08 kPa (SE ±0.003); with PaCO2‐est2 the difference was 0.036 kPa (SE ±0.009). The mean difference between the partial pressure of carbon dioxide and end‐tidal carbon dioxide was 0.72 kPa (SE ±0.01). In a mixed linear model, there was a significant difference between the estimation using end‐tidal carbon dioxide and PaCO2‐est1 (P < .001) and PaCO2‐est2 (P < .001) respectively. Conclusions This novel formula appears to provide an accurate, continuous, and noninvasive estimation of arterial carbon dioxide.

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“…In particular, during the retroperitoneal laparoscopic surgery, the excessive ventilation may increase intrathoracic pressure, reduce pulmonary blood flow, and increase proportion of dead space ventilation. Thus, CO2 partial pressure difference (PaCO2-PETCO2) at the end of expiration will significantly increase (3,9). TcPCO2 causes the temperature of skin surface increase to increase the blood flow velocity in capillary, resulting in arterialization.…”

Section: Discussionmentioning

confidence: 99%

“…It has been indicated that TcPCO2 can accurately (11)(12)(13)(14)(15) predict Pa-CO2 in a real-time manner (4), and has been widely used (8). The most important thing is that TcPCO2 is a valuable supplement to PETCO2 monitoring in patients with a large gap between PaCO2 and PETCO2 and in those concurrently requiring continuous accurate non-invasive control of CO2 levels (4,8,9). But it has also been shown that TcPCO2 -PaCO2 difference will increase (8) in the following settings: PaCO2 above 60 mm Hg (4), hypoperfusion in measurement site, shock, edema, thick skin and vasocontractive drugs.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic and Therapeutic Strategies for Hypercarbia in Elderly Patients Undergoing Prolonged Retroperitoneoscopic Surgery ——The Role of TcPCO2 and PEEP

Kong¹,

Xiao²,

Xu³

et al. 2014

J Anesth Perioper Med

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Diagnostic and therapeutic strategies for hypercarbia in elderly patients undergoing prolonged retroperitoneoscopic surgery -the role of TcPCO2 and PEEP. J Anesth Perioper Med 2014; 1: 63-71.Background: Retroperitoneal laparoscopy provides less operation injury and faster postoperative recovery. However, long-term pneumoperitoneum increases the risk of hypercapnia that may induce severe postoperative complications, especially in elderly patients. Our study aims at investigating the sensitivity and reliability of continuous transcutaneous carbon dioxide (TcPCO2) monitoring in diagnosing hypercapnia during retroperitoneoscopic surgery in elderly patients and evaluating the effect of positive end-expiratory pressure (PEEP) against retroperitoneum induced hypercapnia. Methods: Fifty-five patients aged over 65 years who were scheduled for selective retroperitoneoscopic surgery under general anesthesia were enrolled. The correlations between TcPCO2, end-tidal partial pressure of CO2 (PETCO2) and arterial CO2 (PaCO2) were evaluated before pneumoperitoneum as well as 30 and 60 minutes after establishment of pneumoperitoneum (time 0, 1 and 2), respectively. Patients were randomly assigned to 5 groups accepting different levels of PEEP: 0, 4, 6, 8 and 10 cm H2O (group I, II, III, IV and V). PaCO2 and PETCO2 were measured at 80 minutes following pneumoperitoneum (time 3). Heart rate (HR), arterial pressure, airway pressure were evaluated throughout surgery. Results: There was a significant correlation between TcPCO2 and PaCO2 (r=0.87, P< 0.01), but the correlation between PETCO2 and PaCO2 was lessened with prolonged pneumoperitoneum. The consistency limit (mean ± 2SD) between PaCO2 vs. TcPCO2 and PaCO2 vs. PETCO2 was (-2.86, 5.46) and (-1.61, 20.11) mm Hg, respectively. A difference of ≤5 mm Hg happened in 96% results of PaCO2 vs. TcPCO2 and 32% of PaCO2 vs. PETCO2 (P<0.01). After the use of PEEP, the PaCO2 was increased in group I and II, sustained in group III, but decreased in group IV and V (P<0.05). In addition, PEEP restored the correlation between PETCO2 and PaCO2(r=0.6, P<0.01, N= 55). The hypercapnia induced enhancement of mean arterial pressure (MAP) and HR was normalized by 10 cm H2O PEEP although the airway plateau pressure (PPLAT) and airway pressure peak (PPEAK) values were elevated. Conclusions: TcPCO2 may be used as an alternative non-invasive monitoring to predict the PaCO2 levels in elderly patients undergoing long-term retroperitoneoscopic surgery. PEEP (10 cm H2O) combined with low tidal volume (VT=7 ml/kg) ventilation provides a therapeutic approach to ameliorate pneumoperitoneum-induced hypercapnia in these patients.

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The Application of Transcutaneous CO2 Pressure Monitoring in the Anesthesia of Obese Patients Undergoing Laparoscopic Bariatric Surgery

Cited by 15 publications

References 23 publications

Validity of transcutaneous PCO 2 in monitoring chronic hypoventilation treated with non-invasive ventilation

Validity of transcutaneous PCO 2 in monitoring chronic hypoventilation treated with non-invasive ventilation

Evaluating a novel formula for noninvasive estimation of arterial carbon dioxide during post‐resuscitation care

Diagnostic and Therapeutic Strategies for Hypercarbia in Elderly Patients Undergoing Prolonged Retroperitoneoscopic Surgery ——The Role of TcPCO2 and PEEP

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