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Farenden S, Chung Y, Cui A, Ferguson I. Prospective, observational study investigating the level of agreement between transcutaneous and invasive carbon dioxide measurements in critically ill emergency department patients. Emerg Med J 2023; 40:646-650. [PMID: 37479485 DOI: 10.1136/emermed-2022-212465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/16/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Transcutaneous carbon dioxide (Ptcco2) measurement is a non-invasive surrogate marker for arterial carbon dioxide (Paco2), which requires invasive arterial blood sampling. Use of Ptcco2 has been examined in different clinical settings, however, most existing evidence in the adult emergency department (ED) setting shows insufficient agreement between the measurements. This study assessed the level of agreement between Ptcco2 and Paco2 in undifferentiated adult ED patients across multiple timepoints. METHODS This prospective observational study (study period 2020-2021) assessed paired Ptcco2 and Paco2 measurements at four consecutive timepoints (0, 30, 60 and 90 min) in adult (aged 18 years or over) Australian ED patients requiring hospital admission and arterial catheter insertion. Agreement between the pairs was assessed using Bland-Altman analysis. It was prospectively determined by expert consensus that limits of ±4 mm Hg would be a clinically acceptable level of agreement between Ptcco2 and Paco2. RESULTS During the study period 168 paired Ptcco2 and Paco2 readings were taken from 42 adult ED patients. Bland-Altman analysis showed a mean Ptcco2 reading 3.85 mm Hg higher than Paco2, although at each timepoint the 95% CIs breached the limit of 4 mm Hg difference. In addition, only 66% (111/168) of results fell within the clinically acceptable range. CONCLUSION The level of agreement between Ptcco2 and Paco2 measurements may not be sufficiently precise for the adoption of Ptcco2 monitoring in patients presenting to the ED.
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Affiliation(s)
- Scott Farenden
- Emergency Department, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Yewon Chung
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Amy Cui
- Emergency Department, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Ian Ferguson
- Emergency Department, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ambulance Service of NSW, Rozelle, New South Wales, Australia
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Transcutaneous Carbon Dioxide Monitoring More Accurately Detects Hypercapnia than End-Tidal Carbon Dioxide Monitoring during Non-Intubated Video-Assisted Thoracic Surgery: A Retrospective Cohort Study. J Clin Med 2023; 12:jcm12041706. [PMID: 36836241 PMCID: PMC9962657 DOI: 10.3390/jcm12041706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 02/23/2023] Open
Abstract
Transcutaneous carbon dioxide (PtcCO2) monitoring is known to be effective at estimating the arterial partial pressure of carbon dioxide (PaCO2) in patients with sedation-induced respiratory depression. We aimed to investigate the accuracy of PtcCO2 monitoring to measure PaCO2 and its sensitivity to detect hypercapnia (PaCO2 > 60 mmHg) compared to nasal end-tidal carbon dioxide (PetCO2) monitoring during non-intubated video-assisted thoracoscopic surgery (VATS). This retrospective study included patients undergoing non-intubated VATS from December 2019 to May 2021. Datasets of PetCO2, PtcCO2, and PaCO2 measured simultaneously were extracted from patient records. Overall, 111 datasets of CO2 monitoring during one-lung ventilation (OLV) were collected from 43 patients. PtcCO2 had higher sensitivity and predictive power for hypercapnia during OLV than PetCO2 (84.6% vs. 15.4%, p < 0.001; area under the receiver operating characteristic curve; 0.912 vs. 0.776, p = 0.002). Moreover, PtcCO2 was more in agreement with PaCO2 than PetCO2, indicated by a lower bias (bias ± standard deviation; -1.6 ± 6.5 mmHg vs. 14.3 ± 8.4 mmHg, p < 0.001) and narrower limit of agreement (-14.3-11.2 mmHg vs. -2.2-30.7 mmHg). These results suggest that concurrent PtcCO2 monitoring allows anesthesiologists to provide safer respiratory management for patients undergoing non-intubated VATS.
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Kitajima T, Marumo S, Amimoto H, Shiraishi Y, Yamaki H, Shirata M, Inoue D, Fukui M. Relationship Between Episodic Nocturnal Hypercapnia and History of Exacerbations in Patients with Advanced Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2022; 17:1553-1563. [PMID: 35832833 PMCID: PMC9273152 DOI: 10.2147/copd.s361914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/25/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose An episodic increase in transcutaneous carbon dioxide pressure (PtcCO2) is often recognized in patients with advanced chronic obstructive pulmonary disease (COPD) by overnight PtcCO2 monitoring. This phenomenon, called episodic nocturnal hypercapnia (eNH), mainly corresponds to rapid eye movement (REM) sleep-related hypoventilation. However, it is unclear whether eNH is associated with the frequency of COPD exacerbation. We aimed to investigate whether a relationship exists between COPD exacerbation and eNH. Patients and Methods We enrolled consecutive patients with stable, severe, or very severe COPD with a daytime arterial carbon dioxide pressure (PaCO2) <55.0 mmHg who underwent overnight PtcCO2 monitoring from April 2013 to January 2017. We retrospectively analyzed the prevalence of eNH and sleep-associated hypoventilation (SH) as defined by the American Academy of Sleep Medicine. Moreover, we compared the relationship between the frequency of COPD exacerbations in the previous year and eNH or SH. Results Twenty-four patients were included in this study. The study patients had a mean daytime PaCO2 and nocturnal PtcCO2 of 43.3 ± 6.8 mmHg and 42.9 ± 9.6 mmHg, respectively. Six (25.0%) and 11 (45.9%) of the 24 patients met the SH and eNH criteria, respectively. The odds ratios of SH and eNH for at least one annual exacerbation were 1.0 [95% confidence interval (CI): 0.16–6.00] and 11.1 [95% CI: 1.39–87.7], respectively. The odds ratios of SH and eNH for at least two annual exacerbations were 0.3 [95% CI: 0.04–2.64] and 6.6 [95% CI: 1.06–39.4], respectively. Conclusion In patients with advanced COPD and a daytime PaCO2 <55.0 mmHg, eNH may be associated with a history of more frequent exacerbations than SH. Further studies are required to validate these findings.
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Affiliation(s)
- Takamasa Kitajima
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Satoshi Marumo
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Hisanori Amimoto
- Department of Respiratory Medicine, Kobe City Medical Center West Hospital, Kobe, Japan
| | - Yusuke Shiraishi
- Department of Respiratory Medicine, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Haruka Yamaki
- Department of Respiratory Medicine, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Shirata
- Department of Respiratory Medicine, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Daiki Inoue
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Motonari Fukui
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
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Impact of sleep-related hypoventilation in patients with pleuroparenchymal fibroelastosis. Respir Res 2022; 23:295. [PMID: 36316747 PMCID: PMC9620608 DOI: 10.1186/s12931-022-02224-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Pleuroparenchymal fibroelastosis (PPFE) is a rare fibrosing lung disease with a predilection for the upper lobe and its progression causes hypoventilation, resulting in hypercapnia. Even though the association between sleep-related hypoventilation (SRH) and chronic obstructive pulmonary disease was well documented, its impact in patients with PPFE was not evaluated. The aim of this study is to clarify the impact of SRH on prognosis in PPFE. METHODS A retrospective review of the medical records of 52 patients with PPFE who underwent transcutaneous carbon dioxide monitoring during sleep was done. Patients were stratified into SRH (n = 28) and non-SRH (n = 24) groups based on American Academy of Sleep Medicine criteria. The impact of SRH on the prognosis of PPFE, as well as the clinical factors and comorbidities of PPFE associated with SRH, were evaluated. RESULTS Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), total lung capacity (TLC), and carbon monoxide diffusing capacity (DLco) in the SRH group were significantly lower than the non-SRH group (P < .01). Chronic pulmonary aspergillosis (CPA) was found at a higher rate in the SRH group (P = .02). The median survival time for SRH patients was 330 days, whereas roughly 80% of non-SRH patients were alive during the 3-year observation period (P < .01). Body mass index was a significant prognostic factor in PPFE patients with SRH (HR .78; 95% CI; .64-.94; P < .01). Home oxygen therapy (HOT) during the day and noninvasive positive pressure ventilation (NPPV) at night while sleeping tended to improve prognosis in the SRH group, as indicated by HR of .25 (P = .07). CONCLUSIONS SRH may be a poor prognostic factor for PPFE. Additionally, SRH may modify susceptibility to Aspergillosis in patients with PPFE. HOT plus NPPV may improve the disease outcomes in patients with SRH.
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Mokhlesi B, Won CH, Make BJ, Selim BJ, Sunwoo BY. Optimal Noninvasive Medicare Access Promotion: Patients with Hypoventilation Syndromes A Technical Expert Panel Report from the American College of Chest Physicians, the American Association for Respiratory Care, the American Academy of Sleep Medicine, and the American Thoracic Society. Chest 2021; 160:e377-e387. [PMID: 34339686 DOI: 10.1016/j.chest.2021.06.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/27/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022] Open
Abstract
The existing coverage criteria for home noninvasive ventilation (NIV) do not recognize the diversity of hypoventilation syndromes and advances in technologies. This document summarizes the work of the Hypoventilation Syndromes Technical Expert Panel working group. The most pressing current coverage barriers identified were: 1) overreliance on arterial blood gases (particularly during sleep); 2) need to perform testing on prescribed oxygen; 3) requiring a sleep study to rule out obstructive sleep apnea as the cause of sustained hypoxemia; 4) need for spirometry; 5) need to demonstrate BPAP without a backup rate failure to qualify for BPAP S/T; and 6) qualifying hospitalized patients for home NIV therapy at the time of discharge. Critical evidence support for changes to current policies include randomized clinical trial evidence and clinical practice guidelines. In order to decrease morbidity-mortality by achieving timely access to NIV for patients with hypoventilation, particularly those with obesity hypoventilation syndrome, we make the following key suggestions: 1) Given the significant technological advances, we advise acceptance of surrogate noninvasive end tidal and transcutaneous PCO2 and venous blood gases in lieu of arterial blood gases,; 2) Not requiring PCO2 measures while on prescribed oxygen; 3) Not requiring a sleep study to avoid delays in care in patients being discharged from the hospital; 4) Remove spirometry as a requirement; 5) Not requiring BPAP without a backup rate failure to approve BPAP S/T. The overarching goal of the Technical Expert Panel is to establish pathways that improve clinicians' management capability to provide Medicare beneficiaries access to appropriate home NIV therapy. Adoption of these proposed suggestions would result in the right device, at the right time, for the right type of patients with hypoventilation syndromes.
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Cao M, Stringer WW, Corey S, Orogian A, Cao R, Calmelat R, Lin F, Casaburi R, Rossiter HB, Porszasz J. Transcutaneous PCO 2 for Exercise Gas Exchange Efficiency in Chronic Obstructive Pulmonary Disease. COPD 2021; 18:16-25. [PMID: 33455452 DOI: 10.1080/15412555.2020.1858403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gas exchange inefficiency and dynamic hyperinflation contributes to exercise limitation in chronic obstructive pulmonary disease (COPD). It is also characterized by an elevated fraction of physiological dead space (VD/VT). Noninvasive methods for accurate VD/VT assessment during exercise in patients are lacking. The current study sought to compare transcutaneous PCO2 (TcPCO2) with the gold standard-arterial PCO2 (PaCO2)-and other available methods (end tidal CO2 and the Jones equation) for estimating VD/VT during incremental exercise in COPD. Ten COPD patients completed a symptom limited incremental cycle exercise. TcPCO2 was measured by a heated electrode on the ear-lobe. Radial artery blood was collected at rest, during unloaded cycling (UL) and every minute during exercise and recovery. Ventilation and gas exchange were measured breath-by-breath. Bland-Altman analysis examined agreement of PCO2 and VD/VT calculated using PaCO2, TcPCO2, end-tidal PCO2 (PETCO2) and estimated PaCO2 by the Jones equation (PaCO2-Jones). Lin's Concordance Correlation Coefficient (CCC) was assessed. 114 measurements were obtained from the 10 COPD subjects. The bias between TcPCO2 and PaCO2 was 0.86 mmHg with upper and lower limit of agreement ranging -2.28 mmHg to 3.99 mmHg. Correlation between TcPCO2 and PaCO2 during rest and exercise was r2=0.907 (p < 0.001; CCC = 0.941) and VD/VT using TcPCO2 vs. PaCO2 was r2=0.958 (p < 0.0001; CCC = 0.967). Correlation between PaCO2-Jones and PETCO2 vs. PaCO2 were r2=0.755, 0.755, (p < 0.001; CCC = 0.832, 0.718) and for VD/VT calculation (r2=0.793, 0.610; p < 0.0001; CCC = 0.760, 0.448), respectively. The results support the accuracy of TcPCO2 to reflect PaCO2 and calculate VD/VT during rest and exercise, but not in recovery, in COPD patients, enabling improved accuracy of noninvasive assessment of gas exchange inefficiency during incremental exercise testing.
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Affiliation(s)
- Min Cao
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA.,Department of Cardio-Pulmonary function, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - William W Stringer
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Susan Corey
- Division of Pulmonary and Critical Care, Department of Medicine, Kaiser Permanente, San Diego, CA, USA
| | - Arin Orogian
- Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - Robert Cao
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Robert Calmelat
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Fang Lin
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA.,Department of Respiratory, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Richard Casaburi
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Harry B Rossiter
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA.,Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Janos Porszasz
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
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Perkhofer L, Strobel A, Gagiannis D, Seufferlein T, Schmidt K, Mayer B, Kleger A, Müller M. Transcutaneous carbon dioxide monitoring as a valid complementary method in acute respiratory failure. Eur Respir J 2020; 56:13993003.02137-2020. [DOI: 10.1183/13993003.02137-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/06/2020] [Indexed: 11/05/2022]
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Thomsen LP, Faaborg TH, Rees SE, Weinreich UM. Arterial and transcutaneous variability and agreement between multiple successive measurements of carbon dioxide in patients with chronic obstructive lung disease. Respir Physiol Neurobiol 2020; 280:103486. [PMID: 32615271 DOI: 10.1016/j.resp.2020.103486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/06/2020] [Accepted: 06/26/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study evaluates agreement between carbon dioxide measured arterial (PaCO2) and transcutaneous (PtcCO2) over time, by repeated successive measures, taking into consideration the inherent variability of arterial measurements. METHODS AND RESULTS 11 patients receiving LTOT, with severe to very severe COPD in a stable phase were studied. Repeated arterial blood samples were drawn and PtcCO2 measured simultaneously at the ear lobe. Bland-Altman analysis was used to evaluate 95 % limits of agreement (LoA). 194 paired samples were analysed. Following correction for bias, the difference between PaCO2 and PtCO2 during dynamic conditions was 0.02 kPa and LoA 0.94 to -0.90 kPa while 29 % of PtCO2 measurements were outside the range of variability for arterial measurements. CONCLUSION PtcCO2 corrected for intra-patient bias provide reasonable description of PaCO2 values within but not outside steady state conditions. Our results suggest that PtcCO2 is a valuable method for monitoring in chronic rather than acute conditions when bias can be removed.
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Affiliation(s)
- Lars Pilegaard Thomsen
- Respiratory and Critical Care Group, Department of Medicine and Health Science, Aalborg University, Denmark.
| | - Thea Heide Faaborg
- Department of Respiratory Diseases, Aalborg University Hospital, Denmark
| | - Stephen Edward Rees
- Respiratory and Critical Care Group, Department of Medicine and Health Science, Aalborg University, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Denmark; The Pulmonary Research Centre, Aalborg University Hospital, Denmark; The Clinical Institute, Aalborg University Hospital, Denmark
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Kotsiou OS, Karadontas V, Daniil Z, Zakynthinos E, Gourgoulianis KI. Transcutaneous carbon dioxide monitoring as a predictive tool for all-cause 6-month mortality after acute pulmonary embolism. Eur J Intern Med 2019; 68:44-50. [PMID: 31416659 DOI: 10.1016/j.ejim.2019.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/27/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pulmonary embolism (PE) frequently remains undiagnosed. The partial pressure of carbon dioxide (PaCO2), a surrogate of dead-space ventilation, is useful in the evaluation of the degree of pulmonary artery occlusion. At present, there is no knowledge about the prognostic role of PaCΟ2 variations during the first hours of an acute PE. Transcutaneous measurement of CO2 (PtcCO2) is a simple, non-invasive method that correlates well with PaCO2 levels, evaluated in this study for the first time in patients with PE. PURPOSE To assess the correlation between PtcCO2 and PaCO2 levels in the acute phase of PE and the role of PtcCO2 in predicting 6-months mortality. METHODS This was a pilot study including 53 patients with acute PE who hospitalized in Respiratory Medicine Department at University Hospital of Larissa in central Greece during 15 months. PtcCO2 was constantly monitored for four hours after PE diagnosis with the TCM40 monitoring system (SmartCal). Simultaneous arterial blood gas measurements were performed. Each patient was prospectively recorded for six months via standard telephone calls. RESULTS PaCO2 and PtcCO2 values were well-correlated in the acute phase of PE. Decreased PtcCO2 levels in the first monitoring hour were associated with a higher risk of mortality. In the PE subgroup who died, the lower PtcCO2 level in the first hour of PE was a predictor of shorter survival time independently of gender, age, comorbidities, and smoking status. CONCLUSION PtcCO2 measurement, especially in the first hour after PE, seemed to be a valid tool in predicting all-cause 6-month mortality.
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Affiliation(s)
- Ourania S Kotsiou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500 Larissa, Greece.
| | - Vasileios Karadontas
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500 Larissa, Greece
| | - Zoe Daniil
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500 Larissa, Greece
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Mummery V, Rogers E, Padmanaban V, Matthew D, Woodcock T, Bloch S. Transcutaneous carbon dioxide measurement is not a reliable alternative to arterial blood gas sampling in the acute medical setting. Eur Respir J 2019; 53:13993003.01726-2018. [DOI: 10.1183/13993003.01726-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/23/2018] [Indexed: 11/05/2022]
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Transcutaneous monitoring of partial pressure of carbon dioxide during bronchoscopic procedures performed with jet ventilation: Role of the perfusion index. Eur J Anaesthesiol 2018; 34:703-705. [PMID: 28872579 DOI: 10.1097/eja.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Estimating Arterial Partial Pressure of Carbon Dioxide in Ventilated Patients: How Valid Are Surrogate Measures? Ann Am Thorac Soc 2018; 14:1005-1014. [PMID: 28570147 DOI: 10.1513/annalsats.201701-034fr] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The arterial partial pressure of carbon dioxide (PaCO2) is an important parameter in critically ill, mechanically ventilated patients. To limit invasive procedures or for more continuous monitoring of PaCO2, clinicians often rely on venous blood gases, capnography, or transcutaneous monitoring. Each of these has advantages and limitations. Central venous Pco2 allows accurate estimation of PaCO2, differing from it by an amount described by the Fick principle. As long as cardiac output is relatively normal, central venous Pco2 exceeds the arterial value by approximately 4 mm Hg. In contrast, peripheral venous Pco2 is a poor predictor of PaCO2, and we do not recommend using peripheral venous Pco2 in this manner. Capnography offers measurement of the end-tidal Pco2 (PetCO2), a value that is close to PaCO2 when the lung is healthy. It has the advantage of being noninvasive and continuously available. In mechanically ventilated patients with lung disease, however, PetCO2 often differs from PaCO2, sometimes by a large degree, often seriously underestimating the arterial value. Dependence of PetCO2 on alveolar dead space and ventilator expiratory time limits its value to predict PaCO2. When lung function or ventilator settings change, PetCO2 and PaCO2 can vary in different directions, producing further uncertainty. Transcutaneous Pco2 measurement has become practical and reliable. It is promising for judging steady state values for PaCO2 unless there is overt vasoconstriction of the skin. Moreover, it can be useful in conditions where capnography fails (high-frequency ventilation) or where arterial blood gas analysis is burdensome (clinic or home management of mechanical ventilation).
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Ergan B, Nasiłowski J, Winck JC. How should we monitor patients with acute respiratory failure treated with noninvasive ventilation? Eur Respir Rev 2018; 27:27/148/170101. [PMID: 29653949 DOI: 10.1183/16000617.0101-2017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/21/2017] [Indexed: 12/12/2022] Open
Abstract
Noninvasive ventilation (NIV) is currently one of the most commonly used support methods in hypoxaemic and hypercapnic acute respiratory failure (ARF). With advancing technology and increasing experience, not only are indications for NIV getting broader, but more severe patients are treated with NIV. Depending on disease type and clinical status, NIV can be applied both in the general ward and in high-dependency/intensive care unit settings with different environmental opportunities. However, it is important to remember that patients with ARF are always very fragile with possible high mortality risk. The delay in recognition of unresponsiveness to NIV, progression of respiratory failure or new-onset complications may result in devastating and fatal outcomes. Therefore, it is crucial to understand that timely action taken according to monitoring variables is one of the key elements for NIV success. The purpose of this review is to outline basic and advanced monitoring techniques for NIV during an ARF episode.
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Affiliation(s)
- Begum Ergan
- Division of Intensive Care, Dept of Pulmonary and Critical Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey .,Both authors contributed equally
| | - Jacek Nasiłowski
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland.,Both authors contributed equally
| | - João Carlos Winck
- Northern Rehabilitation Centre Cardio-Pulmonary Group, Vila Nova de Gaia, Respiratory Medicine Units of Trofa-Saúde Alfena Hospital and Braga-Centro Hospital and Faculty of Medicine University of Porto, Porto, Portugal
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Kitajima T, Marumo S, Shima H, Shirata M, Kawashima S, Inoue D, Katayama Y, Itotani R, Sakuramoto M, Fukui M. Clinical impact of episodic nocturnal hypercapnia and its treatment with noninvasive positive pressure ventilation in patients with stable advanced COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:843-853. [PMID: 29563784 PMCID: PMC5846764 DOI: 10.2147/copd.s153200] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Episodic nocturnal hypercapnia (eNH) caused by rapid eye movement (REM) sleep-related hypoventilation is often noted in patients with advanced COPD. The purpose of this study was to clarify the clinical significance of eNH and the effectiveness of eNH-targeted noninvasive positive pressure ventilation (NPPV). Patients and methods We enrolled patients with stable, severe, or very severe COPD with daytime arterial partial oxygen pressure PaO2 ≥55 mmHg and daytime arterial partial carbon dioxide pressure PaCO2 <55 mmHg, who underwent overnight transcutaneous carbon dioxide pressure (PtcCO2) monitoring from April 2013 to April 2016. We retrospectively compared clinical characteristics, daytime blood gas analysis, frequency of exacerbation, serum albumin levels, and ratio of pulmonary artery to aorta diameter (PA:A ratio), between patients with COPD with and without eNH. For those with eNH, we applied NPPV and compared these clinical characteristics before and after NPPV. Results Twenty-one patients were finally included in this study. Ten patients (47.6%) were evaluated to have eNH. These patients had lower albumin levels (p=0.027), larger PA:A ratio (p=0.019), and higher frequency of exacerbations during the last year (p=0.036). NPPV for the patients with eNH improved daytime PaCO2 compared with that 12 months after NPPV (p=0.011). The frequency of exacerbations 1 year before NPPV decreased 1 year after NPPV (p=0.030). Serum albumin levels improved 1 year after NPPV (p=0.001). Conclusion In patients with stable severe or very severe COPD, eNH may be a risk factor of exacerbations, hypoalbuminemia, and pulmonary hypertension. NPPV may be effective against hypoalbuminemia and acute exacerbations. However, further study is necessary to validate these findings.
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Affiliation(s)
- Takamasa Kitajima
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Satoshi Marumo
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Hiroshi Shima
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Masahiro Shirata
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Satoru Kawashima
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Daiki Inoue
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Yuko Katayama
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Ryo Itotani
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Minoru Sakuramoto
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Motonari Fukui
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
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Kelly AM. Agreement between Arterial and Venous Blood Gases In Emergency Medical Care: A Systematic Review. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Aim The objectives of this review are to describe the agreement between arterial and venous blood gas values for pH, pCO2, bicarbonate and base excess. Methods MEDLINE search of papers published 1966-September 2012 for studies comparing arterial and peripheral venous blood gas values for any of pH, pCO2, bicarbonate and base excess in adult patients with any condition in an emergency department setting. The outcome of interest was mean difference weighted for study sample size. Results The weighted mean arterio-venous difference in pH was 0.034 pH units (n=2087), with narrow limits of agreement. The weighted mean arterio-venous difference for pCO2 was 6.2 mmHg (n=1043), but with 95% limits of agreement up to the order of ±20mmHg. Venous pCO2<45 mmHg has 100% sensitivity and negative predictive value for prediction of arterial hypercarbia (n=529). For bicarbonate, the weighted mean difference between arterial and venous values was −1.20 mEq/L (n=1403), with 95% limits of agreement of the order of ±5 mmol/L. Regarding base excess, the mean arterio-venous difference was 0.4 (n=295) but data are conflicting regarding the width of 95% limits of agreement. Conclusion For patients who are not in shock, venous pH and bicarbonate have sufficient agreement to be clinically interchangeable for arterial values. Agreement between arterial and venous pCO2 is too poor and unpredictable to be clinically useful as a one-off test but venous pCO2 may be useful to screen for arterial hypercarbia.
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Validity of transcutaneous PCO 2 in monitoring chronic hypoventilation treated with non-invasive ventilation. Respir Med 2016; 112:112-8. [DOI: 10.1016/j.rmed.2016.01.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/21/2016] [Accepted: 01/23/2016] [Indexed: 11/18/2022]
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Peschanski N, Garcia L, Delasalle E, Mzabi L, Rouff E, Dautheville S, Renai F, Kieffer Y, Lefevre G, Freund Y, Ray P. Can transcutaneous carbon dioxide pressure be a surrogate of blood gas samples for spontaneously breathing emergency patients? The ERNESTO experience. Emerg Med J 2015; 33:325-8. [PMID: 26718224 DOI: 10.1136/emermed-2015-205203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/26/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND It is known that the arterial carbon dioxide pressure (PaCO2) is useful for emergency physicians to assess the severity of dyspnoeic spontaneously breathing patients. Transcutaneous carbon dioxide pressure (PtcCO2) measurements could be a non-invasive alternative to PaCO2 measurements obtained by blood gas samples, as suggested in previous studies. This study evaluates the reliability of a new device in the emergency department (ED). METHODS We prospectively included patients presenting to the ED with respiratory distress who were breathing spontaneously or under non-invasive ventilation. We simultaneously performed arterial blood gas measurements and measurement of PtcCO2 using a sensor placed either on the forearm or the side of the chest and connected to the TCM4 CombiM device. The agreement between PaCO2 and PtcCO2 was assessed using the Bland-Altman method. RESULTS Sixty-seven spontaneously breathing patients were prospectively included (mean age 70 years, 52% men) and 64 first measurements of PtcCO2 (out of 67) were analysed out of the 97 performed. Nineteen patients (28%) had pneumonia, 19 (28%) had acute heart failure and 19 (28%) had an exacerbation of chronic obstructive pulmonary disease. Mean PaCO2 was 49 mm Hg (range 22-103). The mean difference between PaCO2 and PtcCO2 was 9 mm Hg (range -47 to +54) with 95% limits of agreement of -21.8 mm Hg and 39.7 mm Hg. Only 36.3% of the measurement differences were within 5 mm Hg. CONCLUSIONS Our results show that PtcCO2 measured by the TCM4 device could not replace PaCO2 obtained by arterial blood gas analysis.
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Affiliation(s)
- Nicolas Peschanski
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire Tenon Saint Antoine, Assistance-Publique Hôpitaux de Paris (AP-HP), Paris, France Department of Emergency Medicine, Centre Hospitalo-Universitaire Rouen, Rouen, France Institut National de la Sante et de la Recherche Médicale U1096, Université de Rouen, Rouen, France
| | - Léa Garcia
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire Tenon Saint Antoine, Assistance-Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Emilie Delasalle
- Department of Emergency Medicine, Centre Hospitalo-Universitaire Rouen, Rouen, France
| | - Lynda Mzabi
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire Tenon Saint Antoine, Assistance-Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Edwin Rouff
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire Tenon Saint Antoine, Assistance-Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Sandrine Dautheville
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire Tenon Saint Antoine, Assistance-Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Fayrouz Renai
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire Tenon Saint Antoine, Assistance-Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Yann Kieffer
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire Tenon Saint Antoine, Assistance-Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Guillaume Lefevre
- Department of Biochemistry, Centre Hospitalo-Universitaire Tenon Saint Antoine, Paris, France
| | - Yonathan Freund
- Department of Emergency Medicine and Surgery, Groupe Hospitalo-Universitaire Pitié-Salpêtrière, Paris, France DHU Fighting against Ageing and Stress (FAST), Paris Sorbonne Université, Université Paris-06, Paris, France
| | - Patrick Ray
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire Tenon Saint Antoine, Assistance-Publique Hôpitaux de Paris (AP-HP), Paris, France DHU Fighting against Ageing and Stress (FAST), Paris Sorbonne Université, Université Paris-06, Paris, France
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McKeever TM, Hearson G, Housley G, Reynolds C, Kinnear W, Harrison TW, Kelly AM, Shaw DE. Using venous blood gas analysis in the assessment of COPD exacerbations: a prospective cohort study. Thorax 2015; 71:210-5. [PMID: 26628461 PMCID: PMC4789825 DOI: 10.1136/thoraxjnl-2015-207573] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/09/2015] [Indexed: 11/21/2022]
Abstract
Introduction Identifying acute hypercapnic respiratory failure is crucial in the initial management of acute exacerbations of COPD. Guidelines recommend obtaining arterial blood samples but these are more difficult to obtain than venous. We assessed whether blood gas values derived from venous blood could replace arterial at initial assessment. Methods Patients requiring hospital treatment for an exacerbation of COPD had paired arterial and venous samples taken. Bland–Altman analyses were performed to assess agreement between arterial and venous pH, CO2 and . The relationship between SpO2 and SaO2 was assessed. The number of attempts and pain scores for each sample were measured. Results 234 patients were studied. There was good agreement between arterial and venous measures of pH and (mean difference 0.03 and −0.04, limits of agreement −0.05 to 0.11 and −2.90 to 2.82, respectively), and between SaO2 and SpO2 (in patients with an SpO2 of >80%). Arterial sampling required more attempts and was more painful than venous (mean pain score 4 (IQR 2–5) and 1 (IQR 0–2), respectively, p<0.001). Conclusions Arterial sampling is more difficult and more painful than venous sampling. There is good agreement between pH and values derived from venous and arterial blood, and between pulse oximetry and arterial blood gas oxygen saturations. These agreements could allow the initial assessment of COPD exacerbations to be based on venous blood gas analysis and pulse oximetry, simplifying the care pathway and improving the patient experience.
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Affiliation(s)
| | - Glenn Hearson
- Respiratory Research Unit, Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Gemma Housley
- Medical Informatics, East Midlands Academic Health Sciences Network, Nottingham, UK
| | - Catherine Reynolds
- Respiratory Research Unit, Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - William Kinnear
- Respiratory Medicine, Nottingham University Hospital Trust, Nottingham, UK
| | - Tim W Harrison
- Respiratory Research Unit, Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Anne-Maree Kelly
- Emergency Medicine, Joseph Epstein Centre for Emergency Medicine Research, Western Health, St Albans, Victoria, Australia
| | - Dominick E Shaw
- Respiratory Research Unit, Division of Respiratory Medicine, University of Nottingham, Nottingham, UK Medical Informatics, East Midlands Academic Health Sciences Network, Nottingham, UK
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Zhang H, Wang DX. Noninvasive Measurement of Carbon Dioxide during One-Lung Ventilation with Low Tidal Volume for Two Hours: End-Tidal versus Transcutaneous Techniques. PLoS One 2015; 10:e0138912. [PMID: 26466140 PMCID: PMC4605619 DOI: 10.1371/journal.pone.0138912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 09/06/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There may be significant difference between measurement of end-tidal carbon dioxide partial pressure (PetCO2) and arterial carbon dioxide partial pressure (PaCO2) during one-lung ventilation with low tidal volume for thoracic surgeries. Transcutaneous carbon dioxide partial pressure (PtcCO2) monitoring can be used continuously to evaluate PaCO2 in a noninvasive fashion. In this study, we compared the accuracy between PetCO2 and PtcCO2 in predicting PaCO2 during prolonged one-lung ventilation with low tidal volume for thoracic surgeries. METHODS Eighteen adult patients who underwent thoracic surgeries with one-lung ventilation longer than two hours were included in this study. Their PetCO2, PtcCO2, and PaCO2 values were collected at five time points before and during one-lung ventilation. Agreement among measures was evaluated by Bland-Altman analysis. RESULTS Ninety sample sets were obtained. The bias and precision when PtcCO2 and PaCO2 were compared were 4.1 ± 6.5 mmHg during two-lung ventilation and 2.9 ± 6.1 mmHg during one-lung ventilation. Those when PetCO2 and PaCO2 were compared were -11.8 ± 6.4 mmHg during two-lung ventilation and -11.8 ± 4.9 mmHg during one-lung ventilation. The differences between PtcCO2 and PaCO2 were significantly lower than those between PetCO2 and PaCO2 at all five time-points (p < 0.05). CONCLUSIONS PtcCO2 monitoring was more accurate for predicting PaCO2 levels during prolonged one-lung ventilation with low tidal volume for patients undergoing thoracic surgeries.
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Affiliation(s)
- Hong Zhang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
- * E-mail:
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Piquilloud L, Thevoz D, Jolliet P, Revelly JP. End-tidal carbon dioxide monitoring using a naso-buccal sensor is not appropriate to monitor capnia during non-invasive ventilation. Ann Intensive Care 2015; 5:2. [PMID: 25852962 PMCID: PMC4385013 DOI: 10.1186/s13613-014-0042-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/30/2014] [Indexed: 11/30/2022] Open
Abstract
Background In acute respiratory failure, arterial blood gas analysis (ABG) is used to diagnose hypercapnia. Once non-invasive ventilation (NIV) is initiated, ABG should at least be repeated within 1 h to assess PaCO2 response to treatment in order to help detect NIV failure. The main aim of this study was to assess whether measuring end-tidal CO2 (EtCO2) with a dedicated naso-buccal sensor during NIV could predict PaCO2 variation and/or PaCO2 absolute values. The additional aim was to assess whether active or passive prolonged expiratory maneuvers could improve the agreement between expiratory CO2 and PaCO2. Methods This is a prospective study in adult patients suffering from acute hypercapnic respiratory failure (PaCO2 ≥ 45 mmHg) treated with NIV. EtCO2 and expiratory CO2 values during active and passive expiratory maneuvers were measured using a dedicated naso-buccal sensor and compared to concomitant PaCO2 values. The agreement between two consecutive values of EtCO2 (delta EtCO2) and two consecutive values of PaCO2 (delta PaCO2) and between PaCO2 and concomitant expiratory CO2 values was assessed using the Bland and Altman method adjusted for the effects of repeated measurements. Results Fifty-four datasets from a population of 11 patients (8 COPD and 3 non-COPD patients), were included in the analysis. PaCO2 values ranged from 39 to 80 mmHg, and EtCO2 from 12 to 68 mmHg. In the observed agreement between delta EtCO2 and deltaPaCO2, bias was −0.3 mmHg, and limits of agreement were −17.8 and 17.2 mmHg. In agreement between PaCO2 and EtCO2, bias was 14.7 mmHg, and limits of agreement were −6.6 and 36.1 mmHg. Adding active and passive expiration maneuvers did not improve PaCO2 prediction. Conclusions During NIV delivered for acute hypercapnic respiratory failure, measuring EtCO2 using a dedicating naso-buccal sensor was inaccurate to predict both PaCO2 and PaCO2 variations over time. Active and passive expiration maneuvers did not improve PaCO2 prediction. Trial registration ClinicalTrials.gov: NCT01489150.
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Affiliation(s)
- Lise Piquilloud
- Adult Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | - David Thevoz
- Adult Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland ; Cardio-Respiratory Physiotherapy Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | - Philippe Jolliet
- Adult Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jean-Pierre Revelly
- Adult Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland
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Liu X, Kruger P, Maibach H, Colditz PB, Roberts MS. Using skin for drug delivery and diagnosis in the critically ill. Adv Drug Deliv Rev 2014; 77:40-9. [PMID: 25305335 DOI: 10.1016/j.addr.2014.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 09/09/2014] [Accepted: 10/01/2014] [Indexed: 02/08/2023]
Abstract
Skin offers easy access, convenience and non-invasiveness for drug delivery and diagnosis. In principle, these advantages of skin appear to be attractive for critically ill patients given potential difficulties that may be associated with oral and parenteral access in these patients. However, the profound changes in skin physiology that can be seen in these patients provide a challenge to reliably deliver drugs or provide diagnostic information. Drug delivery through skin may be used to manage burn injury, wounds, infection, trauma and the multisystem complications that rise from these conditions. Local anaesthetics and analgesics can be delivered through skin and may have wide application in critically ill patients. To ensure accurate information, diagnostic tools require validation in the critically ill patient population as information from other patient populations may not be applicable.
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Ansari S, Hosseinzadeh H, Dennis S, Zwar N. Patients' perspectives on the impact of a new COPD diagnosis in the face of multimorbidity: a qualitative study. NPJ Prim Care Respir Med 2014; 24:14036. [PMID: 25119845 PMCID: PMC4373407 DOI: 10.1038/npjpcrm.2014.36] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 06/21/2014] [Accepted: 07/01/2014] [Indexed: 11/12/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD), a major cause of morbidity and mortality worldwide, often occurs in the presence of comorbidities, which may influence experience and management of the disease. No prior research seems to have gained perspectives of newly diagnosed primary care COPD patients in the context of multimorbidity. Aims: This qualitative study aimed to explore the impact of a new diagnosis of COPD in the context of multimorbidity and also sought to gain a better understanding of how patients react to the diagnosis and incorporate it into their lives. Methods: Participants were identified from a cohort of primary care patients with multimorbidity recently diagnosed with COPD. Data was collected via semi-structured interviews from nine male and eight female participants. Thematic analysis was performed and the data interpreted from a constructivist perspective. Results: Five core themes regarding COPD were induced: (i) reaction to diagnosis, (ii) impact on function and health behaviour, (iii) factors influencing self-management capacity, (iv) healthcare utilisation and (v) interplay of comorbidities. Most participants had difficulty recognising the importance of COPD and its long-term implications. For many, the salience of another chronic condition outweighed COPD. Self-management capacity and utilisation of healthcare services were challenged by low prioritisation of COPD among other comorbidities. Conclusions: This study provides an insight into how primary care patients feel about being diagnosed with COPD, as well as their prioritisation of the disease in the context of multimorbidity. It highlights the need for tailored education and personalised management incorporating patients’ perspectives in primary care.
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Affiliation(s)
- Sameera Ansari
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Sydney, NSW, Australia
| | - Hassan Hosseinzadeh
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Sydney, NSW, Australia
| | - Sarah Dennis
- 1] School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Sydney, NSW, Australia [2] Clinical and Rehabilitation Sciences, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Nicholas Zwar
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Sydney, NSW, Australia
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Kim JY, Yoon YH, Lee SW, Choi SH, Cho YD, Park SM. Accuracy of transcutaneous carbon dioxide monitoring in hypotensive patients. Emerg Med J 2013; 31:323-6. [DOI: 10.1136/emermed-2012-202228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectivesContinuous blood gas monitoring is frequently necessary in critically ill patients. Our aim was to assess the accuracy of transcutaneous CO2 tension (PtcCO2) monitoring in the emergency department (ED) assessment of hypotensive patients by comparing it with the gold standard of arterial blood gas analysis (ABGA).MethodsAll patients receiving PtcCO2 monitoring in the ED were included. We excluded paediatric patients, patients with no ABGA results during a hypotensive event, patients whose ABGA was not performed simultaneously with PtcCO2 monitoring, and patients who received sodium bicarbonate for resuscitation. The included patients were classified into hypotensive patients and normotensive patients. A hypotensive patient was defined as a patient showing a mean arterial pressure under 60 mm Hg. The agreement in measurement between PaCO2 tension (PaCO2) and PtcCO2 were investigated in both groups.ResultsThe mean difference between PaCO2 and PtcCO2 was 2.1 mm Hg, and the Bland–Altman limits of agreement (bias±1.96 SD) ranged from −15.6 to 19.7 mm Hg in the 28 normotensive patients. The mean difference between PaCO2 and PtcCO2 was 1.1 mm Hg, and the Bland–Altman limits of agreement (bias±1.96 SD) ranged from −19.5 to 21.7 mm Hg in the 26 hypotensive patients. The weighted κ values were 0.64 in the normotensive patients and 0.60 in the hypotensive patients.ConclusionsPtcCO2 monitoring showed wider limits of agreement with PaCO2 in urgent situations in the ED environment. However, acutely developed hypotension does not affect the accuracy of PtcCO2 monitoring.
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Nicolini A, Ferrari MB. Evaluation of a transcutaneous carbon dioxide monitor in patients with acute respiratory failure. Ann Thorac Med 2012; 6:217-20. [PMID: 21977067 PMCID: PMC3183639 DOI: 10.4103/1817-1737.84776] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 05/05/2011] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Non-invasive measurement of oxygenation is a routine procedure in clinical practice, but transcutaneous monitoring of PCO(2)(PtCO(2)) is used much less than expected. METHODS The aim of our study was to analyze the value of a commercially available combined SpO(2)/PtCO(2) monitor (TOSCA-Linde Medical System, Basel, Switzerland) in adult non-invasive ventilated patients with acute respiratory failure. Eighty critically ill adult patients, requiring arterial blood sample gas analyses, underwent SpO(2) and PtCO(2) measurements (10 min after the probe was attached to an earlobe) simultaneously with arterial blood sampling. The level of agreement between PaCO(2) - PtCO(2) and SaO(2) - SpO(2)was assessed by Bland-Altman analyses. RESULTS Both, SaO(2) from blood gas analysis and SpO(2) from the transcutaneous monitor, and PaCO(2) and PtCO(2) were equally useful. No measurements were outside of the acceptable clinical range of agreement of ± 7.5 mmHg. CONCLUSIONS The accuracy of estimation of the TOSCA transcutaneous electrode (compared with the "gold standard" blood sample gas analysis) was generally good. Moreover, TOSCA presents the advantage of the possibility of continuous non-invasive measurement. The level of agreement of the two methods of measurement allows us to state that the TOSCA sensor is useful in routine monitoring of adults admitted to an intermediate respiratory unit and undergoing non-invasive ventilation.
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Affiliation(s)
- Antonello Nicolini
- Department of Respiratory Diseases, Hospital of Sestri Levante, Chiavarese, Italy
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Rubortone SA, De Carolis MP, Lacerenza S, Bersani I, Occhipinti F, Romagnoli C. Use of a combined SpO₂/PtcCO₂ sensor in the delivery room. SENSORS 2012; 12:10980-9. [PMID: 23112642 PMCID: PMC3472870 DOI: 10.3390/s120810980] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 07/16/2012] [Accepted: 07/31/2012] [Indexed: 11/16/2022]
Abstract
Arterial oxygen saturation (SaO2) and partial arterial pressure of carbon dioxide (PaCO2) are important respiratory parameters in critically ill neonates. A sensor combining a pulse oximeter with the Stow-Severinghaus electrode, required for the measurement of peripheral oxygen saturation (SpO2) and transcutaneous partial pressure of carbon dioxide (PtcCO2), respectively, has been recently used in neonatal clinical practice (TOSCA500ÒRadiometer). We evaluated TOSCA usability and reliability in the delivery room (DR), throughout three different periods, on term, late-preterm, and preterm neonates. During the first period (period A), 30 healthy term neonates were simultaneously monitored with both TOSCA and a MASIMO pulse oximeter. During the second period (period B), 10 healthy late-preterm neonates were monitored with both TOSCA and a transcutaneous device measuring PtcCO2 (TINAÒ TCM3, Radiometer). During the third period (period C), 15 preterm neonates were monitored with TOSCA and MASIMO after birth, during stabilization, and during transport to the neonatal intensive care unit (NICU). Blood gas analyses were performed to compare transcutaneous and blood gas values. TOSCA resulted easily and safely usable in the DR, allowing reliable noninvasive SaO2 estimation. Since PtcCO2 measurements with TOSCA required at least 10 min to be stable and reliable, this parameter was not useful during the early resuscitation immediately after birth. Moreover, PtcCO2 levels were less precise if compared to the conventional transcutaneous monitoring. However, PtcCO2 measurement by TOSCA was useful as trend-monitoring after stabilization and during transport to NICU.
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Affiliation(s)
- Serena Antonia Rubortone
- Division of Neonatology, Department of Paediatrics, Catholic University of Sacred Heart, Largo Gemelli 8, I-00168 Rome, Italy.
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Concordance between transcutaneous and arterial measurements of carbon dioxide in an ED. Am J Emerg Med 2012; 30:1872-6. [PMID: 22795407 DOI: 10.1016/j.ajem.2012.03.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 03/29/2012] [Accepted: 03/30/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Transcutaneous carbon dioxide pressure (PtcCO(2)) has been suggested as a noninvasive surrogate of arterial carbon dioxide pressure (PaCO(2)). Our study evaluates the reliability of this method in spontaneously breathing patients in an emergency department. PATIENTS AND METHODS A prospective, observational study was performed in nonintubated dyspneic patients who required measurement of arterial blood gases. Simultaneously and blindly to the physicians in charge, PtcCO(2) was measured using a TOSCA 500 monitor (Radiometer, Villeurbanne, France). Agreement between PaCO(2) and PtcCO(2) was assessed using the Bland-Altman method. RESULTS Forty-eight patients (mean age, 65 years) were included, and 50 measurements were done. Eleven (23%) had acute heart failure; 10 (21%), pneumonia; 7 (15%), acute asthma; and 7 (15%), exacerbation of chronic obstructive pulmonary disease. Median PaCO(2) was 42 mm Hg (range, 17-109). Mean difference between PaCO(2) and PtcCO(2) was 1 mm Hg with 95% limits of agreement of -3.4 to +5.6 mm Hg. All measurement differences were within 5 mm Hg, and 32 (64%) were within 2 mm Hg. CONCLUSION Transcutaneous carbon dioxide pressure accurately predicts PaCO(2) in spontaneously breathing patients.
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Gancel PE, Masson R, Du Cheyron D, Roupie E, Lofaso F, Terzi N. PCO2 transcutanée: pourquoi, comment et pour qui ? MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-012-0450-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Real-time monitoring of blood carbon dioxide tension by fluorosensor. Respir Physiol Neurobiol 2012; 180:141-6. [DOI: 10.1016/j.resp.2011.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 10/26/2011] [Accepted: 10/27/2011] [Indexed: 11/18/2022]
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