Volumetric capnography

Suárez-Sipmann, Fernando; Böhm, Stephan H.; Tusman, Gerardo

doi:10.1097/mcc.0000000000000095

Cited by 95 publications

(50 citation statements)

References 31 publications

(17 reference statements)

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“…Also, we did not measure other parameters such as inflammatory mediators or lung volumes. The calculation of dead space using the Enghoff modification of Bohr equation in patients with large shunt fractions (>20–30 %) could underestimate dead space fraction [12]. In our study, we did not measure intrapulmonary shunt.…”

Section: Discussionmentioning

confidence: 91%

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End-inspiratory pause prolongation in acute respiratory distress syndrome patients: effects on gas exchange and mechanics

Aguirre-Bermeo

Morán

Bottiroli

et al. 2016

Ann. Intensive Care

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BackgroundEnd-inspiratory pause (EIP) prolongation decreases dead space-to-tidal volume ratio (Vd/Vt) and PaCO2. We do not know the physiological benefits of this approach to improve respiratory system mechanics in acute respiratory distress syndrome (ARDS) patients when mild hypercapnia is of no concern.MethodsThe investigation was conducted in an intensive care unit of a university hospital, and 13 ARDS patients were included. The study was designed in three phases. First phase, baseline measurements were taken. Second phase, the EIP was prolonged until one of the following was achieved: (1) EIP of 0.7 s; (2) intrinsic positive end-expiratory pressure ≥1 cmH2O; or (3) inspiratory–expiratory ratio 1:1. Third phase, the Vt was decreased (30 mL every 30 min) until PaCO2 equal to baseline was reached. FiO2, PEEP, airflow and respiratory rate were kept constant.ResultsEIP was prolonged from 0.12 ± 0.04 to 0.7 s in all patients. This decreased the Vd/Vt and PaCO2 (0.70 ± 0.07 to 0.64 ± 0.08, p < 0.001 and 54 ± 9 to 50 ± 8 mmHg, p = 0.001, respectively). In the third phase, the decrease in Vt (from 6.3 ± 0.8 to 5.6 ± 0.8 mL/Kg PBW, p < 0.001) allowed to decrease plateau pressure and driving pressure (24 ± 3 to 22 ± 3 cmH2O, p < 0.001 and 13.4 ± 3.6 to 10.9 ± 3.1 cmH2O, p < 0.001, respectively) and increased respiratory system compliance from 29 ± 9 to 32 ± 11 mL/cmH2O (p = 0.001). PaO2 did not significantly change.ConclusionsProlonging EIP allowed a significant decrease in Vt without changes in PaCO2 in passively ventilated ARDS patients. This produced a significant decrease in plateau pressure and driving pressure and significantly increased respiratory system compliance, which suggests less overdistension and less dynamic strain.

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Section: Discussionmentioning

confidence: 91%

“…The use of this equation implies the use of PaCO 2 as surrogate for alveolar carbon dioxide. Therefore, this equation measures a global index of efficiency of gas exchange because it takes also shunt effect into account [12]. …”

Section: Introductionmentioning

confidence: 99%

End-inspiratory pause prolongation in acute respiratory distress syndrome patients: effects on gas exchange and mechanics

Aguirre-Bermeo

Morán

Bottiroli

et al. 2016

Ann. Intensive Care

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“…To estimate FECO 2 , we quantitated % concentration of CO 2 from the capnograph waveform (Figure 4). 27 The small increase in partial pressure of carbon dioxide (PCO 2 ), noted as phase Ι in Figure 4, marks the transition from inspiration to expiration. This is followed by a significant increase in PCO 2 , labeled phase ΙΙ.…”

Section: Methodsmentioning

confidence: 99%

Dissociated Oxygen Consumption and Carbon Dioxide Production in the Post–Cardiac Arrest Rat: A Novel Metabolic Phenotype

Shinozaki

Becker

Saeki³

et al. 2018

JAHA

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BackgroundThe concept that resuscitation from cardiac arrest (CA) results in a metabolic injury is broadly accepted, yet patients never receive this diagnosis. We sought to find evidence of metabolic injuries after CA by measuring O2 consumption and CO2 production (VCO 2) in a rodent model. In addition, we tested the effect of inspired 100% O2 on the metabolism.Methods and ResultsRats were anesthetized and randomized into 3 groups: resuscitation from 10‐minute asphyxia with inhaled 100% O2 (CA–fraction of inspired O2 [FIO2] 1.0), with 30% O2 (CA‐FIO 2 0.3), and sham with 30% O2 (sham‐FIO 2 0.3). Animals were resuscitated with manual cardiopulmonary resuscitation. The volume of extracted O2 (VO 2) and VCO 2 were measured for a 2‐hour period after resuscitation. The respiratory quotient (RQ) was RQ=VCO 2/VO 2. VCO 2 was elevated in CA‐FIO 2 1.0 and CA‐FIO 2 0.3 when compared with sham‐FIO 2 0.3 in minutes 5 to 40 after resuscitation (CA‐FIO 2 1.0: 16.7±2.2, P<0.01; CA‐FIO 2 0.3: 17.4±1.4, P<0.01; versus sham‐FIO 2 0.3: 13.6±1.1 mL/kg per minute), and then returned to normal. VO 2 in CA‐FIO 2 1.0 and CA‐FIO 2 0.3 increased gradually and was significantly higher than sham‐FIO 2 0.3 2 hours after resuscitation (CA‐FIO 2 1.0: 28.7±6.7, P<0.01; CA‐FIO 2 0.3: 24.4±2.3, P<0.01; versus sham‐FIO 2 0.3: 15.8±2.4 mL/kg per minute). The RQ of CA animals persistently decreased (CA‐FIO 2 1.0: 0.54±0.12 versus CA‐FIO 2 0.3: 0.68±0.05 versus sham‐FIO 2 0.3: 0.93±0.11, P<0.01 overall).Conclusions CA altered cellular metabolism resulting in increased VO 2 with normal VCO 2. Normal VCO 2 suggests that the postresuscitation Krebs cycle is operating at a presumably healthy rate. Increased VO 2 in the face of normal VCO 2 suggests a significant alteration in O2 utilization in postresuscitation. Several RQ values fell well outside the normally cited range of 0.7 to 1.0. Higher FIO 2 may increase VO 2, leading to even lower RQ values.

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“…[12] Monitoring of dead space by volumetric capnography also aids in setting optimal PEEP. [1314] This was shown in a study where the “best PEEP” coincided with best pulmonary compliance, which also coincided with lowest Enghoff physiological dead space and maximum oxygen transport.…”

Section: Discussionmentioning

confidence: 99%

Titration of ideal positive end-expiratory pressure in acute respiratory distress syndrome: Comparison between lower inflection point and esophageal pressure method using volumetric capnography

Baikunje

Sehgal

Dhooria

et al. 2017

Indian Journal of Critical Care Medicine

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The tenets of mechanical ventilation in acute respiratory distress syndrome (ARDS) include the utilization of low tidal volume and optimal application of positive end-expiratory pressure (PEEP). Optimal PEEP in ARDS is characterized by reduction in alveolar dead space along with improvement in the lung compliance and resultant betterment in oxygenation. There are various methods of setting PEEP in ARDS. Herein, we report a patient of ARDS, wherein we employed measurement of dead space using volumetric capnography to compare two different PEEP strategies, namely, the lower inflection point and transpulmonary pressure monitoring.

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Volumetric capnography

Cited by 95 publications

References 31 publications

End-inspiratory pause prolongation in acute respiratory distress syndrome patients: effects on gas exchange and mechanics

End-inspiratory pause prolongation in acute respiratory distress syndrome patients: effects on gas exchange and mechanics

Dissociated Oxygen Consumption and Carbon Dioxide Production in the Post–Cardiac Arrest Rat: A Novel Metabolic Phenotype

Titration of ideal positive end-expiratory pressure in acute respiratory distress syndrome: Comparison between lower inflection point and esophageal pressure method using volumetric capnography

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