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Jin Z, Yang M, Lin R, Huang W, Wang J, Hu Z, Shu Q. Application of end-tidal carbon dioxide monitoring via distal gas samples in ventilated neonates. Pediatr Neonatol 2017; 58:370-375. [PMID: 28511794 DOI: 10.1016/j.pedneo.2017.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/22/2016] [Accepted: 01/23/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Previous research has suggested correlations between the end-tidal partial pressure of carbon dioxide (PETCO2) and the partial pressure of arterial carbon dioxide (PaCO2) in mechanically ventilated patients, but both the relationship between PETCO2 and PaCO2 and whether PETCO2 accurately reflects PaCO2 in neonates and infants are still controversial. This study evaluated remote sampling of PETCO2 via an epidural catheter within an endotracheal tube to determine the procedure's clinical safety and efficacy in the perioperative management of neonates. METHODS Abdominal surgery was performed under general anesthesia in 86 full-term newborns (age 1-30 days, weight 2.55-4.0 kg, American Society of Anesthesiologists class I or II). The infants were divided into 2 groups (n = 43 each), and carbon dioxide (CO2) gas samples were collected either from the conventional position (the proximal end) or a modified position (the distal end) of the epidural catheter. RESULTS The PETCO2 measured with the new method was significantly higher than that measured with the traditional method, and the difference between PETCO2 and PaCO2 was also reduced. The accuracy of PETCO2 measured increased from 78.7% to 91.5% when the modified sampling method was used. The moderate correlation between PETCO2 and PaCO2 by traditional measurement was 0.596, which significantly increased to 0.960 in the modified sampling group. Thus, the PETCO2 value was closer to that of PaCO2. CONCLUSION PETCO2 detected via modified carbon dioxide monitoring had a better accuracy and correlation with PaCO2 in neonates.
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Affiliation(s)
- Ziying Jin
- Department of Anesthesiology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
| | - Maoying Yang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Binjiang District, Hangzhou, Zhejiang Province, China
| | - Ru Lin
- Department of Thoracic Surgery, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Wenfang Huang
- Department of Anesthesiology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jiangmei Wang
- Department of Anesthesiology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Zhiyong Hu
- Department of Anesthesiology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Qiang Shu
- Department of Thoracic Surgery, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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Sajedi P, Abooei M, Shafa A, Karbalaei M, Babaei A. Evaluation the effect of breathing filters on end-tidal carbon dioxide during inferior abdominal surgery in infants and changes of tidal volume and respiratory rate needs for preventing of increasing end-tidal carbon dioxide. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:115. [PMID: 28255323 PMCID: PMC5331765 DOI: 10.4103/1735-1995.193506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/03/2016] [Accepted: 08/15/2016] [Indexed: 11/17/2022]
Abstract
Background: The aim of this study was to prevent of increasing end-tidal carbon dioxide (ETCO2) with changing of vital capacity and respiratory rate when using of birthing filter in infants. Materials and Methods: In a randomized clinical trial study, ninety-four infant’ patients were studied in three groups. Basic values, such as peak inspiratory pressure, tidal volume, minute ventilation, respiratory rate, and partial pressure of ET CO2 (PETCO2) level had been evaluated after intubation, 10 min after intubation and 10 min after filter insertion. In the first group, patients only observed for changing in ETCO2 level. In the second and the third groups, respiratory rates and tidal volume had been increased retrospectively, until that ETCO2 ≤35 mmHg was received. We used ANOVA, Chi-square, and descriptive tests for data analysis. P < 0.05 was considered statistically significant. Results: Tidal volume 10 min after filter insertion was statistically higher in Group 3 (145.0 ± 26.3 ml) versus 129.3 ± 38.9 ml in Group 1 and 118.7 ± 20.8 ml in Group 2 (P = 0.02). Furthermore, respiratory rate at this time was statistically higher in Group 2 (25.82 ± 0.43) versus Groups 1 and 3 (21.05 ± 0.20 ml and 21.02 ± 0.60 ml, respectively) (P = 0.001). Minute volume and PETCO2 level were statistically significant between Group 1 and the other two groups after filter insertion (P = 0.01 and P = 0.00,1 respectively). Conclusion: With changing the vital capacity and respiratory rate we can control PETCO2 level ≤35 mmHg during using of birthing filters in infants. We recommend this instrument during anesthesia of infants.
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Affiliation(s)
- Parvin Sajedi
- Department of Anesthesia and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Abooei
- Department of Anesthesia and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Shafa
- Department of Anesthesia and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahboobeh Karbalaei
- Department of Nurse Anesthesia, AL Zahra Medical Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atefeh Babaei
- Department of Anesthesia and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran
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Tymko MM, Hoiland RL, Kuca T, Boulet LM, Tremblay JC, Pinske BK, Williams AM, Foster GE. Measuring the human ventilatory and cerebral blood flow response to CO2: a technical consideration for the end-tidal-to-arterial gas gradient. J Appl Physiol (1985) 2016; 120:282-96. [DOI: 10.1152/japplphysiol.00787.2015] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/19/2015] [Indexed: 11/22/2022] Open
Abstract
Our aim was to quantify the end-tidal-to-arterial gas gradients for O2 (PET-PaO2) and CO2 (Pa-PETCO2) during a CO2 reactivity test to determine their influence on the cerebrovascular (CVR) and ventilatory (HCVR) response in subjects with (PFO+, n = 8) and without (PFO−, n = 7) a patent foramen ovale (PFO). We hypothesized that 1) the Pa-PETCO2 would be greater in hypoxia compared with normoxia, 2) the Pa-PETCO2 would be similar, whereas the PET-PaO2 gradient would be greater in those with a PFO, 3) the HCVR and CVR would be underestimated when plotted against PETCO2 compared with PaCO2, and 4) previously derived prediction algorithms will accurately target PaCO2. PETCO2 was controlled by dynamic end-tidal forcing in steady-state steps of −8, −4, 0, +4, and +8 mmHg from baseline in normoxia and hypoxia. Minute ventilation (V̇E), internal carotid artery blood flow (Q̇ICA), middle cerebral artery blood velocity (MCAv), and temperature corrected end-tidal and arterial blood gases were measured throughout experimentation. HCVR and CVR were calculated using linear regression analysis by indexing V̇E and relative changes in Q̇ICA, and MCAv against PETCO2, predicted PaCO2, and measured PaCO2. The Pa-PETCO2 was similar between hypoxia and normoxia and PFO+ and PFO−. The PET-PaO2 was greater in PFO+ by 2.1 mmHg during normoxia ( P = 0.003). HCVR and CVR plotted against PETCO2 underestimated HCVR and CVR indexed against PaCO2 in normoxia and hypoxia. Our PaCO2 prediction equation modestly improved estimates of HCVR and CVR. In summary, care must be taken when indexing reactivity measures to PETCO2 compared with PaCO2.
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Affiliation(s)
- Michael M. Tymko
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, Canada; and
| | - Ryan L. Hoiland
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, Canada; and
| | - Tomas Kuca
- Department of Anesthesia, Pain and Perioperative Medicine, Department of Critical Care Medicine, Dalhousie University, Halifax, Canada
| | - Lindsey M. Boulet
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, Canada; and
| | - Joshua C. Tremblay
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, Canada; and
| | - Bryenna K. Pinske
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, Canada; and
| | - Alexandra M. Williams
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, Canada; and
| | - Glen E. Foster
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, Canada; and
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Tymko MM, Ainslie PN, MacLeod DB, Willie CK, Foster GE. End tidal-to-arterial CO2 and O2 gas gradients at low- and high-altitude during dynamic end-tidal forcing. Am J Physiol Regul Integr Comp Physiol 2015; 308:R895-906. [DOI: 10.1152/ajpregu.00425.2014] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/23/2015] [Indexed: 11/22/2022]
Abstract
We sought to characterize and quantify the performance of a portable dynamic end-tidal forcing (DEF) system in controlling the partial pressure of arterial CO2 (PaCO2) and O2 (PaO2) at low (LA; 344 m) and high altitude (HA; 5,050 m) during an isooxic CO2 test and an isocapnic O2 test, which is commonly used to measure ventilatory and vascular reactivity in humans ( n = 9). The isooxic CO2 tests involved step changes in the partial pressure of end-tidal CO2 (PetCO2) of −10, −5, 0, +5, and +10 mmHg from baseline. The isocapnic O2 test consisted of a 10-min hypoxic step (PetO2 = 47 mmHg) from baseline at LA and a 5-min euoxic step (PetO2 = 100 mmHg) from baseline at HA. At both altitudes, PetO2 and PetCO2 were controlled within narrow limits (<1 mmHg from target) during each protocol. During the isooxic CO2 test at LA, PetCO2 consistently overestimated PaCO2 ( P < 0.01) at both baseline (2.1 ± 0.5 mmHg) and hypercapnia (+5 mmHg: 2.1 ± 0.7 mmHg; +10 mmHg: 1.9 ± 0.5 mmHg). This Pa-PetCO2 gradient was approximately twofold greater at HA ( P < 0.05). At baseline at both altitudes, PetO2 overestimated PaO2 by a similar extent (LA: 6.9 ± 2.1 mmHg; HA: 4.5 ± 0.9 mmHg; both P < 0.001). This overestimation persisted during isocapnic hypoxia at LA (6.9 ± 0.6 mmHg) and during isocapnic euoxia at HA (3.8 ± 1.2 mmHg). Step-wise multiple regression analysis, on the basis of the collected data, revealed that it may be possible to predict an individual's arterial blood gases during DEF. Future research is needed to validate these prediction algorithms and determine the implications of end-tidal-to-arterial gradients in the assessment of ventilatory and/or vascular reactivity.
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Affiliation(s)
- Michael M. Tymko
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, Canada; and
| | - Philip N. Ainslie
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, Canada; and
| | - David B. MacLeod
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Chris K. Willie
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, Canada; and
| | - Glen E. Foster
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, Canada; and
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de la Matta-Martín M, López-Herrera D, Luis-Navarro JC, López-Romero JL. Effects of inhalational anaesthesia with low tidal volume ventilation on end-tidal sevoflurane and carbon dioxide concentrations: prospective randomized study. ACTA ACUST UNITED AC 2013; 61:78-86. [PMID: 24373754 DOI: 10.1016/j.redar.2013.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 05/26/2013] [Accepted: 06/04/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We investigated how ventilation with low tidal volumes affects the pharmacokinetics of sevoflurane uptake during the first minutes of inhaled anaesthesia. METHODS Forty-eight patients scheduled for lung resection were randomly assigned to three groups. Patients in group 1, 2 and 3 received 3% sevoflurane for 3 min via face mask and controlled ventilation with a tidal volume of 2.2, 8 and 12 ml kg(-1), respectively (Phase 1). After tracheal intubation (Phase 2), 3% sevoflurane was supplied for 2 min using a tidal volume of 8 ml kg(-1) (Phase 3). RESULTS End-tidal sevoflurane concentrations were significantly higher in group 1 at the end of phase 1 and lower at the end of phase 2 than in the other groups as follows: median of 2.5%, 2.2% and 2.3% in phase 1 for groups 1, 2 and 3, respectively (P<0.001); and 1.7%, 2.1% and 2.0% in phase 2, respectively (P<0.001). End-tidal carbon dioxide values in group 1 were significantly lower at the end of phase 1 and higher at the end of phase 2 than in the other groups as follows: median of 16.5, 31 and 29.5 mm Hg in phase 1 for groups 1, 2 and 3, respectively (P<0.001); and 46.2, 36 and 33.5 mm Hg in phase 2, respectively (P<0.001). CONCLUSION When sevoflurane is administered with tidal volume approximating the airway dead space volume, end-tidal sevoflurane and end-tidal carbon dioxide may not correctly reflect the concentration of these gases in the alveoli, leading to misinterpretation of expired gas data.
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Affiliation(s)
- M de la Matta-Martín
- Anesthesia Department, General Hospital, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - D López-Herrera
- Anesthesia Department, General Hospital, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J C Luis-Navarro
- Anesthesia Department, General Hospital, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J L López-Romero
- Anesthesia Department, General Hospital, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Davis DP, Davis PW. A structural model of perfusion and oxygenation in low-flow states. Resuscitation 2011; 82:1444-52. [DOI: 10.1016/j.resuscitation.2011.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 05/11/2011] [Accepted: 05/18/2011] [Indexed: 10/18/2022]
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Increased apparatus dead space and tidal volume increase blood concentrations of oxygen and sevoflurane in overweight patients: a randomised controlled clinical study. Eur J Anaesthesiol 2011; 28:382-6. [DOI: 10.1097/eja.0b013e328344b4b2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Enekvist B, Bodelsson M, Sturesson LW, Johansson A. Larger tidal volume increases sevoflurane uptake in blood: a randomized clinical study. Acta Anaesthesiol Scand 2010; 54:1111-6. [PMID: 20887413 DOI: 10.1111/j.1399-6576.2010.02291.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The rate of uptake of volatile anesthetics is dependent on alveolar concentration and ventilation, blood solubility and cardiac output. We wanted to determine whether increased tidal volume (V(T)), with unchanged end-tidal carbon dioxide partial pressure (P(ET)CO(2)), could affect the arterial concentration of sevoflurane. METHODS Prospective, randomized, clinical study. ASA physical status (2) and II patients scheduled for elective surgery of the lower abdomen were randomly assigned to one of the two groups with 10 patients in each: one group with normal V(T) (NV(T)) and one group with increased V(T) (IV(T)) achieved by increasing the inspired plateau pressure 0.04 cmH(2)O/kg above the initial plateau pressure. A corrugated tube added extra apparatus dead space to maintain P(ET)CO(2) at 4.5 kPa. The respiratory rate was set at 15 min(-1), and sevoflurane was delivered to the fresh gas by a vaporizer set at 3%. Arterial sevoflurane tensions (P(a)sevo), F(i)sevo, P(ET)sevo, P(ET)CO(2), P(a)CO(2), V(T) and airway pressure were measured. RESULTS The two groups of patients were similar with regard to gender, age, weight, height and body mass index. The mean P(ET)sevo did not differ between the groups. Throughout the observation time, arterial sevoflurane tension (mean ± SE) was significantly higher in the IV(T) group compared with the NV(T) group, e.g. 1.9 ± 0.23 vs. 1.6 ± 0.25 kPa after 60 min of anesthesia (P<0.05). CONCLUSION Ventilation with larger tidal volumes with isocapnia maintained with added dead-space volume increases the tension of sevoflurane in arterial blood.
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Affiliation(s)
- B Enekvist
- Section of Anaesthesiology and Intensive Care, Department of Clinical Sciences, Lund University, Lund, Sweden.
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