Weaning Mechanical Ventilation After Off-Pump Coronary Artery Bypass Graft Procedures Directed by Noninvasive Gas Measurements

Chakravarthy, Murali; Narayan, Sandeep; Govindarajan, Raghav; Jawali, Vivek; Subramanyam, Rajeev

doi:10.1053/j.jvca.2009.06.015

Cited by 4 publications

(1 citation statement)

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“…The clinical value of SEE THE RELATED EDITORIAL ON PAGE 623 transcutaneous data are still questionable, with only one reported trial assessing subject management based on P tcCO 2 readings alone. 13 A key limitation is that during COPD exacerbation (the most common NIV indication 14 ), arterial blood samples must still be taken to measure pH.…”

Section: Introductionmentioning

confidence: 99%

What Is the Potential Role of Transcutaneous Carbon Dioxide in Guiding Acute Noninvasive Ventilation?

2014

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BACKGROUND: Transcutaneous carbon dioxide (P tcCO 2 ) monitoring is rarely used in the acute hospital setting, where serial samples of arterial blood are instead taken to measure carbon dioxide tension (P aCO 2 ). In this pilot observational study, we assessed the potential of P tcCO 2 monitoring to calculate pH and guide management of acute noninvasive ventilation (NIV). METHODS: Ten subjects with acute hypercapnic respiratory failure were recruited. All had arterial lines placed to guide acute NIV. P tcCO 2 was monitored for 12 h (TOSCA TCM4) and compared with P aCO 2 . Noninvasive transcutaneous pH was determined from P tcCO 2 and calculated bicarbonate and then compared with true arterial pH. Agreements between P CO 2 and pH methods were assessed using Bland-Altman analysis of limits of agreement and Pearson correlation coefficients. Hypothetical adjustments to acute NIV settings were based on transcutaneous data alone and evaluated in comparison with true management. Pain scores for each method were compared using the Wilcoxon signed-rank test. RESULTS: P CO 2 time trends were concordant. Mean P CO 2 bias was ؊2.33 (95% limits of agreement of ؊9.60 to 5.03) mm Hg, and r ‫؍‬ 0.89 (P < .001). Mean pH bias was 0.012 (95% limits of agreement of ؊0.070 to 0.094), and r ‫؍‬ 0.84 (P < .001). Hypothetical clinical decisions based on transcutaneous data alone matched true management on 85% of 34 occasions. Initiation of transcutaneous monitoring was less painful than the arterial equivalent (P ‫؍‬ .008). CONCLUSIONS: This pilot study demonstrates that P tcCO 2 monitoring provides a continuous and reliable trend and also allows pH prediction. This patient-friendly approach is a promising alternative to repeated arterial blood gas sampling in patients requiring NIV for acute hypercapnic respiratory failure.

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Section: Introductionmentioning

confidence: 99%