Transcutaneous monitoring as a replacement for arterial PCO2 monitoring during nocturnal non-invasive ventilation

Storre, Jan Hendrik; Magnet, Friederike Sophie; Dreher, Michael; Windisch, Wolfram

doi:10.1016/j.rmed.2010.10.007

Cited by 114 publications

(116 citation statements)

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“…Most studies previously reporting agreement have used arterial blood gases, which is the accepted standard. 2,4,14 Recently, good correlation was also reported between P tcCO 2 measurements and venous samples among pediatric subjects. 11 In our study, 41% of simultaneous P tcCO 2 and blood gas values were capillary samples.…”

Section: Discussionmentioning

confidence: 95%

“…We also found wider agreement limits of 12.2 to Ϫ22.5 compared with some prior studies. 4,5,13,14 Our study, however, evaluates a large blood gas-P tcCO 2 sample over the entire span of an infant's ventilated course, making fluctuation in agreement more likely. Further, Ͼ80% of our population is constituted by very low birthweight infants, in whom a lower correlation has been reported, compared with pediatric and adult studies.…”

Section: Discussionmentioning

confidence: 99%

“…Based on previous literature we chose Ϯ7 mm Hg as a clinically acceptable bias. 5,[13][14][15] Clinical outcomes were culture-proven sepsis before (early onset) and after (late onset) 3 days of life; ՆGrade III intraventricular hemorrhage; bronchopulmonary dysplasia, defined as respiratory support or oxygen requirement at 36 weeks gestation (for neonates born Ͻ32 weeks) or at 28 days of life (for infants Ն32 weeks gestation at birth); necrotizing enterocolitis classified as ՆBells stage II, including spontaneous intestinal perforation; patent ductus arteriosus diagnosed by echocardiogram or clinically and treated; and type 1 retinopathy of prematurity by ETROP (Early Treatment for Retinopathy of Prematurity) criteria. 16 …”

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

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Neonatal Transcutaneous Carbon Dioxide Monitoring—Effect on Clinical Management and Outcomes

2015

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BACKGROUND: This work aimed to compare frequency of blood gas measurements per day of mechanical ventilation, occurrence of extreme blood gas CO 2 values, and clinical outcomes among ventilated neonates managed with and without transcutaneous carbon dioxide (P tcCO 2 ) monitors. This work also measures agreement between simultaneous P tcCO 2 and blood gas CO 2 measurements and ascertains factors that affect agreement. METHODS: This is a cohort study with retrospective analysis comparing 5,726 blood gas measurements and clinical outcomes for 123 neonates intubated for >48 h before and after the introduction of transcutaneous carbon-di-oxide monitoring devices in a single tertiary care unit. RESULTS: Median (interquartile range) blood gas frequency per mechanical ventilation day was 3.9 (2.6 -5.3) and 2.9 (2.1-4.0) before and after P tcCO 2 monitoring (P ‫؍‬ .002) without differences in clinical outcomes at discharge. After adjusting for confounders using Poisson regression, this difference remained significant. The mean ؎ 2 SD blood gas-P tcCO 2 difference was ؊5.2 ؎ 17.3 mm Hg. 64% of simultaneous blood gas-P tcCO 2 measurements per subject were within ؎7 mm Hg. Greater bias was noted with arterial sample and during the use of high-frequency ventilation. CONCLUSION: Despite only moderate agreement between simultaneous P tcCO 2 and blood gas measurements, P tcCO 2 monitoring statistically decreased blood gas frequency among ventilated neonates without affecting the duration of mechanical ventilation or clinical outcomes at discharge. The clinical impact of this technology appears to be minimal.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

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Neonatal Transcutaneous Carbon Dioxide Monitoring—Effect on Clinical Management and Outcomes

2015

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“…It is a useful measuring instrument when it is necessary to know the behavioral tendency of arterial gases 1,2,3 . During the polysomnographic (PSG) examination, carbon dioxide tension (PCO 2 ) and oxygen saturation (SatO 2 ) are important measurements for characterization of respiratory events related to sleep 4 .…”

Section: Introductionmentioning

confidence: 99%

“…In addition, cutaneous arterialization processes were found to be safe at temperatures up to 44°C, allowing the electrode to remain in contact with the patient for a longer period of time without damages 5,10 . These improvements have contributed to increase reliability and safety of the method 1 . The objective of this study was to establish normative values for PtcCO 2 during the polysomnographic recording in patients whose age group varied from 7 to 76 years old, defined as normal.…”

Section: Introductionmentioning

confidence: 99%

Analysis of mean transcutaneous capnography in consecutive patients undergoing polysomnography

Pinnola¹,

Bastos²

2014

Arq. Neuro-Psiquiatr.

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Transcutaneous capnography is a noninvasive method useful for analysis of the behavioral tendency of transcutaneous CO 2 pressure (PtcCO 2 ) in patients undergoing polysomnography, to evaluate respiratory sleep disorders. Objective: Determine normative PtcCO 2 values in normal patients undergoing polysomnography. Method: One hundred seventy-nine patients who underwent polysomnography with simultaneous PtcCO 2 measurement were assessed by means of a transcutaneous capnograph (TCM4 series from Radiomiter). Results: The group classified as normal (N=53) presented a apnea/hypopnea index (AHI) ,5 events/per hour of sleep and their age groups varied between 7 and 76 years of age. Conclusion: Global mean values of PtcCO 2 in the normal group had a Gaussian distribution that varied between 33.1 and 50.0 mmHg (SD 4,363). Such findings allowed the establishment of normative PtcCO 2 values for normal individuals.

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Hypoventilation Syndromes

Piper

Yee

2014

Comprehensive Physiology

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In patients with impaired inspiratory muscle function or altered respiratory system mechanics, an imbalance between load and capacity can arise. The ventilatory control system normally compensates for this by increasing drive to maintain adequate alveolar ventilation levels, thereby keeping arterial CO2 within its normal range. To reduce work of breathing, a pattern of reduced tidal volume and increased respiratory rate occurs. This pattern itself may eventually reduce effective ventilation by increasing dead space ventilation. However, the impact of sleep on breathing and its role in the development of diurnal respiratory failure is often overlooked in this process. Sleep not only reduces respiratory drive, but also diminishes chemoresponsiveness to hypoxia and hypercapnia creating an environment where significant alterations in oxygenation and CO2 can occur. Acute increases in CO2 load especially during rapid eye movement sleep can initiate the process of bicarbonate retention which further depresses ventilatory responsiveness to CO2. Treatment of hypoventilation needs to be directed toward factors underlying its development. Nocturnal noninvasive positive pressure therapy is the most widely used and reliable strategy currently available to manage hypoventilation syndromes. Although this may not consistently alter respiratory muscle strength or the mechanical properties of the respiratory system, it does appear to reset chemosensitivity by reducing bicarbonate, resulting in a more appropriate ventilatory response to CO2 during wakefulness. Not only is diurnal hypoventilation reduced with noninvasive ventilation, but quality of life, functional capacity and survival are also improved. However, close attention to how therapy is set up and used are key factors in achieving clinical benefits.

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Transcutaneous monitoring as a replacement for arterial PCO2 monitoring during nocturnal non-invasive ventilation

Abstract: DRKS00000433 at http://apps.who.int/trialsearch/default.aspx.

Cited by 114 publications

References 45 publications

Neonatal Transcutaneous Carbon Dioxide Monitoring—Effect on Clinical Management and Outcomes

Neonatal Transcutaneous Carbon Dioxide Monitoring—Effect on Clinical Management and Outcomes

Analysis of mean transcutaneous capnography in consecutive patients undergoing polysomnography

Hypoventilation Syndromes

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