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Mostafa MF, Mamdouh Osman A, Reda Mohamed Abdallah A, Mostafa Thabet A, Abbas Hassan S. Non-invasive carbon dioxide monitoring during moderate sedation at different oxygen flow rates in patients undergoing endoscopic retrograde cholangio-pancreatography. EGYPTIAN JOURNAL OF ANAESTHESIA 2023. [DOI: 10.1080/11101849.2023.2168848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Mohamed F. Mostafa
- Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ayman Mamdouh Osman
- Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Ahmed Mostafa Thabet
- Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Shimaa Abbas Hassan
- Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Michael FA, Peveling-Oberhag J, Herrmann E, Zeuzem S, Bojunga J, Friedrich-Rust M. Evaluation of the Integrated Pulmonary Index® during non-anesthesiologist sedation for percutaneous endoscopic gastrostomy. J Clin Monit Comput 2021; 35:1085-1092. [PMID: 32734356 PMCID: PMC8497449 DOI: 10.1007/s10877-020-00563-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/21/2020] [Indexed: 12/22/2022]
Abstract
Standard monitoring of heart rate, blood pressure and arterial oxygen saturation during endoscopy is recommended by current guidelines on procedural sedation. A number of studies indicated a reduction of hypoxic (art. oxygenation < 90% for > 15 s) and severe hypoxic events (art. oxygenation < 85%) by additional use of capnography. Therefore, U.S. and the European guidelines comment that additional capnography monitoring can be considered in long or deep sedation. Integrated Pulmonary Index® (IPI) is an algorithm-based monitoring parameter that combines oxygenation measured by pulse oximetry (art. oxygenation, heart rate) and ventilation measured by capnography (respiratory rate, apnea > 10 s, partial pressure of end-tidal carbon dioxide [PetCO2]). The aim of this paper was to analyze the value of IPI as parameter to monitor the respiratory status in patients receiving propofol sedation during PEG-procedure. Patients reporting for PEG-placement under sedation were randomized 1:1 in either standard monitoring group (SM) or capnography monitoring group including IPI (IM). Heart rate, blood pressure and arterial oxygen saturation were monitored in SM. In IM additional monitoring was performed measuring PetCO2, respiratory rate and IPI. Capnography and IPI values were recorded for all patients but were only visible to the endoscopic team for the IM-group. IPI values range between 1 and 10 (10 = normal; 8-9 = within normal range; 7 = close to normal range, requires attention; 5-6 = requires attention and may require intervention; 3-4 = requires intervention; 1-2 requires immediate intervention). Results on capnography versus standard monitoring of the same study population was published previously. A total of 147 patients (74 in SM and 73 in IM) were included in the present study. Hypoxic events occurred in 62 patients (42%) and severe hypoxic events in 44 patients (29%), respectively. Baseline characteristics were equally distributed in both groups. IPI = 1, IPI < 7 as well as the parameters PetCO2 = 0 mmHg and apnea > 10 s had a high sensitivity for hypoxic and severe hypoxic events, respectively (IPI = 1: 81%/81% [hypoxic/severe hypoxic event], IPI < 7: 82%/88%, PetCO2: 69%/68%, apnea > 10 s: 84%/84%). All four parameters had a low specificity for both hypoxic and severe hypoxic events (IPI = 1: 13%/12%, IPI < 7: 7%/7%, PetCO2: 29%/27%, apnea > 10 s: 7%/7%). In multivariate analysis, only SM and PetCO2 = 0 mmHg were independent risk factors for hypoxia. IPI (IPI = 1 and IPI < 7) as well as the individual parameters PetCO2 = 0 mmHg and apnea > 10 s allow a fast and convenient conclusion on patients' respiratory status in a morbid patient population. Sensitivity is good for most parameters, but specificity is poor. In conclusion, IPI can be a useful metric to assess respiratory status during propofol-sedation in PEG-placement. However, IPI was not superior to PetCO2 and apnea > 10 s.
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Affiliation(s)
- Florian Alexander Michael
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Jan Peveling-Oberhag
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
- Department of Internal Medicine 1, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Eva Herrmann
- Institute of Biostatistic and Mathematical Modelling, Goethe-University, Frankfurt, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Jörg Bojunga
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
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Evaluation and application of a method for estimating nasal end-tidal O 2 fraction while administering supplemental O 2. J Clin Monit Comput 2019; 33:1071-1080. [PMID: 30725266 DOI: 10.1007/s10877-019-00264-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Abstract
This paper describes a method for estimating the oxygen enhanced end-tidal fraction of oxygen (FetOe), the end-tidal fraction of oxygen (FetO2) that is raised by administering supplemental oxygen. The paper has two purposes: the first is to evaluate the method's accuracy on the bench and in volunteers; the second purpose is to demonstrate how to apply the method to compare two techniques of oxygen administration. The method estimates FetOe by analyzing expired oxygen as oxygen washes out of the lung. The method for estimating FetOe was first validated using a bench simulation in which tracheal oxygen was measured directly. Then it was evaluated in 30 healthy volunteers and compared to the bench simulation. Bland-Altman analysis compared calculated and observed FetOe/FetO2 measurements. After the method was evaluated, it was implemented to compare the FetOe obtained when administering oxygen using two different techniques (pulsed and continuous flow). A total of eighteen breath washout conditions were evaluated on the bench. FetOe estimates and tracheal FetO2 had a mean difference of - 0.016 FO2 with 95% limits of agreement from - 0.048 to 0.016 FO2. Thirteen breath washouts per volunteer were analyzed. Extrapolated and observed FetO2 had a mean difference of - 0.001 FO2 with 95% limits of agreement from - 0.006 to 0.004 FO2. Pulsed flow oxygen (PFO) achieved the same FetOe values as continuous flow oxygen (CFO) using 32.1% ± 2.27% (mean ± SD) of the CFO rate. This paper has demonstrated that the method estimates FetO2 enhanced by administering supplemental oxygen with clinically insignificant differences. This paper has also shown that PFO can obtain FetO2 similar to CFO using approximately one-third of the oxygen volume. After evaluating this method, we conclude that the method provides useful estimates of nasal FetO2 enhanced by supplemental oxygen administration.
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Burk KM, Sakata DJ, Kuck K, Orr JA. Comparing Nasal End-Tidal Carbon Dioxide Measurement Variation and Agreement While Delivering Pulsed and Continuous Flow Oxygen in Volunteers and Patients. Anesth Analg 2019; 130:715-724. [PMID: 30633057 DOI: 10.1213/ane.0000000000004004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Supplemental oxygen is administered during procedural sedation to prevent hypoxemia. Continuous flow oxygen, the most widespread method, is generally adequate but distorts capnography. Pulsed flow oxygen is novel and ideally will not distort capnography. We have developed a prototype oxygen administration system designed to try to facilitate end-tidal carbon dioxide (ETCO2) measurement. We conducted a volunteer study (ClinicalTrials.gov, NCT02886312) to determine how much nasal ETCO2 measurements vary with oxygen flow rate. We also conducted a clinical study (NCT02962570) to determine the median difference and limits of agreement between ETCO2 measurements made with and without administering oxygen. METHODS Both studies were conducted at the University of Utah and participants acted as their own control. Inclusion criteria were age 18 years and older with an American Society of Anesthesiologists physical status of I-III. Exclusion criteria included acute respiratory distress syndrome, pneumonia, lung or cardiovascular disease, nasal/bronchial congestion, pregnancy, oxygen saturation measured by pulse oximetry <93%, and a procedure scheduled for <20 minutes. For the volunteer study, pulsed and continuous flow was administered at rates from 2 to 10 L/min using a single sequence of technique and flow. The median absolute deviation from the median value was analyzed for the primary outcome of ETCO2. For the clinical study, ETCO2 measurements (the primary outcome) were collected while administering pulsed and continuous flow at rates between 1 and 5 L/min and were compared to measurements without oxygen flow. Due to institutional review board requirements for patient safety, this study was not randomized. After completing the study, measurements with and without administering oxygen were analyzed to determine median differences and 95% limits of agreement for each administration technique. RESULTS Thirty volunteers and 60 patients participated in these studies which ended after enrolling the predetermined number of participants. In volunteers, the median absolute deviation for ETCO2 measurements made while administering pulsed flow oxygen (0.89; 25%-75% quantiles: 0.3-1.2) was smaller than while administering continuous flow oxygen (3.93; 25%-75% quantiles: 2.2-6.2). In sedated patients, the median difference was larger during continuous flow oxygen (-6.8 mm Hg; 25%-75% quantiles: -12.5 to -2.1) than during pulsed flow oxygen (0.1 mm Hg; 25%-75% quantiles: -0.5 to 1.5). The 95% limits of agreement were also narrower during pulsed flow oxygen (-2.4 to 4.5 vs -30.5 to 2.4 mm Hg). CONCLUSIONS We have shown that nasal ETCO2 measurements while administering pulsed flow have little deviation and agree well with measurements made without administering oxygen. We have also demonstrated that ETCO2 measurements during continuous flow oxygen have large deviation and wide limits of agreement when compared with measurements made without administering oxygen.
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Affiliation(s)
- Kyle M Burk
- From the Departments of Anesthesiology and Bioengineering, University of Utah, Salt Lake City, Utah
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Oral capnography is more effective than nasal capnography during sedative upper gastrointestinal endoscopy. J Clin Monit Comput 2017; 32:321-326. [DOI: 10.1007/s10877-017-0029-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/06/2017] [Indexed: 01/08/2023]
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Bertrand HGMJ, Ellen YC, O'Keefe S, Flecknell PA. Comparison of the effects of ketamine and fentanyl-midazolam-medetomidine for sedation of rhesus macaques (Macaca mulatta). BMC Vet Res 2016; 12:93. [PMID: 27277424 PMCID: PMC4898395 DOI: 10.1186/s12917-016-0721-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 06/03/2016] [Indexed: 11/22/2022] Open
Abstract
Background This study assessed the effects of sedation using a combination of fentanyl, midazolam and medetomidine in comparison to ketamine. Rhesus Macaques (Macaca mulatta), (n = 16, 5 males and 3 females randomly allocated to each treatment group) received either ketamine (KET) (10 mg.kg−1) or fentanyl-midazolam-medetomidine (FMM) (10 μg/kg−1; 0.5 mg.kg−1; 20 μg.kg−1) both IM. Oxygen (100 %) was provided by mask and heart rate, blood pressure, respiratory rate, EtCO2 and depth of sedation were assessed every 5 min for 20 min. After the last time point, FMM monkeys were reversed with atipamezole-naloxone (0.2 mg.kg−1; 10 μg.kg−1). Recovery was scored using clinical scoring scheme. Differences in physiological parameters and quality of sedation were compared using Area Under the Curve (AUC) method and either Mann-Witney or t-student tests. Results Heart rate (beats/min) (Ket = 119 ± 18; FMM = 89 ± 17; p = 0.0066), systolic blood pressure (mmHg) (Ket = 109 ± 10; FMM = 97 ± 10; p = 0.0313), and respiratory rate (breaths/min) (Ket = 39 ± 9; FMM = 29 ± 10; p = 0.0416) were significantly lower in the FMM group. End-tidal CO2 (mmHg) did not differ between the groups (KET = 33 ± 8; FMM = 42 ± 11; p = 0.0462). Although some depression of physiological parameters was seen with FMM, the variables all remained within the normal ranges in both groups. Onset of a sufficient degree of sedation for safe handling was more rapid with ketamine (KET = 2.9 ± 1.4 min; FMM = 7.9 ± 1.2 min; p = 0.0009), but FMM recovery was faster (KET = 21.4 ± 13.4 min; FMM = 9.1 ± 3.6 min; p = 0.0379) and of better quality (KET = 1.3 ± 0.9; FMM = 7.4 ± 1.9; p = 0.0009) most probably because of the effectiveness of the reversal agents used. Conclusion FMM provides an easily reversible immobilization with a rapid and good recovery quality and may prove a useful alternative to ketamine.
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Affiliation(s)
- Henri G M J Bertrand
- Comparative Biology Centre, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK. .,Faculty of Veterinary Medicine, University of Liège, Boulevard de Colonster, Liège, 4000, Belgium.
| | - Yvette C Ellen
- Comparative Biology Centre, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK.,School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK
| | - Stevie O'Keefe
- Comparative Biology Centre, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Paul A Flecknell
- Comparative Biology Centre, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK.,Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK
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Ebert TJ, Novalija J, Uhrich TD, Barney JA. The effectiveness of oxygen delivery and reliability of carbon dioxide waveforms: a crossover comparison of 4 nasal cannulae. Anesth Analg 2015; 120:342-8. [PMID: 25390281 DOI: 10.1213/ane.0000000000000537] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Effective O2 delivery and accurate end-tidal CO2 (ETCO2) sampling are essential features of nasal cannulae (NCs) in patients with compromised respiratory status. We studied 4 NC designs: bifurcated nasal prongs (NPs) with O2 delivery and CO2 sensing in both NPs (Hudson), separate O2/CO2 NPs (Salter), and CO2 sensing in NPs with cloud O2 delivery outside the NPs via multi vents (Oridion) and dual vents (Medline). We hypothesized that design differences between NCs would influence O2 delivery and ETCO2 detection. METHODS Forty-five healthy volunteers, 18 to 35 years, participated in an unrestricted, randomized block design, each subject serving as their own control in a 4-period crossover study design of 4 NCs during one session. Monitoring included electrocardiogram, posterior pharynx O2 sampling from a Hauge Airway (Sharn Anesthesia Products, Tampa, FL), and NC ETCO2. In 11 volunteers, radial artery blood was sampled from a catheter for partial pressures of O2 and carbon dioxide (PaO2 and PaCO2) determination. Per randomization, each NC was positioned, and data were collected over 2 minutes (ETCO2, pharyngeal O2, PaO2, and PaCO2) during room air and during O2 fresh gas flows (FGFs) of 2, 4, and 6 Lpm. Statistical analyses were performed with SAS Analytics Pro, Version 9.3, and JMP Statistical Software, Version 11 (SAS Institute Inc., Cary, NC), significance at P < 0.05. RESULTS Blood gas analyses indicated PaCO2 during steady state at each experimental time period remained unchanged from physiologic baseline. PaO2 did not differ between NC devices at baseline or 2 Lpm O2. The PaO2 at 4 Lpm from the separate NPs and bifurcated NCs was significantly higher than the multi-vented NC. Pharyngeal O2 with the NC with separate NPs was significantly higher than multivented and dual-vented cloud delivery NCs at 2, 4, and 6 Lpm FGF. Pharyngeal O2 with the NC with bifurcated NPs was significantly higher than the multi-vented NC at 2 Lpm, and higher than cloud delivery NCs at 4 and 6 Lpm FGF. ETCO2 was significantly lower with the NC with bifurcated NPs compared to the other 3 NCs, consistent with errant CO2 tracings at higher FGF. CONCLUSIONS NCs provide supplemental inspired O2 concentrations for patients with impaired pulmonary function. Accurate measures of ETCO2 are helpful in assessing respiratory rate and determining whether CO2 retention is occurring from hypoventilation. These findings suggest the NC with separate NPs was the most effective in delivering O2 and the most consistent at providing reliable CO2 waveforms at higher FGFs.
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Affiliation(s)
- Thomas J Ebert
- From the Department of Anesthesiology, Medical College of Wisconsin and VA Medical Center, Milwaukee, Wisconsin
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Zhao D, Miller D, Xian X, Tsow F, Forzani ES. A Novel Real-time Carbon Dioxide Analyzer for Health and Environmental Applications. SENSORS AND ACTUATORS. B, CHEMICAL 2014; 195:171-176. [PMID: 24659857 PMCID: PMC3959738 DOI: 10.1016/j.snb.2013.12.110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
To be able to detect carbon dioxide (CO2) with high accuracy and fast response time is critical for many health and environmental applications. We report on a pocket-sized CO2 sensor for real-time analysis of end-tidal CO2, and environmental CO2. The sensor shows fast and reversible response to CO2 over a wide concentration range, covering the needs of both environmental and health applications. It is also immune to the presence of various interfering gases in ambient or expired air. Furthermore, the sensor has been used for real-time breath analysis, and the results are in good agreement with those from a commercial CO2 detector.
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Affiliation(s)
- Di Zhao
- Center for Bioelectronics and Biosensors, Biodesign Institute, Arizona State University, Tempe, Arizona 85287-5801, United States ; School of Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona 85287-5801, United States
| | - Dylan Miller
- Center for Bioelectronics and Biosensors, Biodesign Institute, Arizona State University, Tempe, Arizona 85287-5801, United States ; School of Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona 85287-5801, United States
| | - Xiaojun Xian
- Center for Bioelectronics and Biosensors, Biodesign Institute, Arizona State University, Tempe, Arizona 85287-5801, United States
| | - Francis Tsow
- Center for Bioelectronics and Biosensors, Biodesign Institute, Arizona State University, Tempe, Arizona 85287-5801, United States
| | - Erica S Forzani
- Center for Bioelectronics and Biosensors, Biodesign Institute, Arizona State University, Tempe, Arizona 85287-5801, United States ; School of Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona 85287-5801, United States
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Sbaraglia F, Garra R, Lorusso R, De Riso M, Sammartino M. The bright side of sedation: 'May the EtCO(2) be with you!'. Paediatr Anaesth 2012; 22:582-3. [PMID: 22594412 DOI: 10.1111/j.1460-9592.2012.03839.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mimoz O, Benard T, Gaucher A, Frasca D, Debaene B. Accuracy of respiratory rate monitoring using a non-invasive acoustic method after general anaesthesia. Br J Anaesth 2012; 108:872-5. [PMID: 22323525 DOI: 10.1093/bja/aer510] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Respiratory rate should be monitored continuously in the post-anaesthesia care unit (PACU) to avoid any delay in the detection of respiratory depression. Capnometry is the standard of care but in extubated patients requires a nasal cannula or a face mask that may be poorly tolerated or can be dislodged, leading to errors in data acquisition and false alarms. The value of a new non-invasive acoustic monitor in this setting has not been fully investigated. METHODS Adult patients admitted to the PACU after general anaesthesia were included. After tracheal extubation, an adhesive sensor with an integrated acoustic transducer (RRa™) was placed on the patient's throat and connected to its monitor while the patient breathed through a face mask with a carbon dioxide sampling port (Capnomask™) connected to a capnometer. Both the acoustic monitor and the capnometer were connected to a computer to record one pair of data per second for up to 60 min. RESULTS Fifty-two patients, mean (range) age 54 (22-84) yr and BMI 26 (19-39) kg m(-2), were studied. Compared with capnometry, the bias and limits of agreement of the acoustic method were 0 (-1.4-1.4) bpm. The acoustic sensor was well tolerated while the face mask was removed by eight patients, leading to study discontinuation in two patients. CONCLUSIONS In extubated patients, continuous assessment of respiration rate with an acoustic monitor correlated well with capnometry.
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Affiliation(s)
- O Mimoz
- Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, Poitiers, France.
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Gaucher A, Frasca D, Mimoz O, Debaene B. Accuracy of respiratory rate monitoring by capnometry using the Capnomask(R) in extubated patients receiving supplemental oxygen after surgery. Br J Anaesth 2011; 108:316-20. [PMID: 22157953 DOI: 10.1093/bja/aer383] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Respiratory monitoring is standard after anaesthesia and surgery. Abnormal respiratory rate is a sensitive indicator of respiratory problems, even in patients receiving supplemental oxygen, but the best method for its continuous measurement in spontaneously breathing patients is unclear. This study compared respiratory rate assessment by capnometry using a new oxygen mask with a carbon dioxide sampling port (Capnomask(®)) and thoracic impedance pneumography with clinical measurement (used as a reference method) in extubated patients receiving supplemental oxygen. METHODS Adult males admitted to the post-anaesthesia care unit after general anaesthesia were studied. Immediately after extubation, a Capnomask(®) connected to a capnometer was positioned appropriately. Respiratory rate was measured by visual inspection of chest movement for 1 min, by capnometry, and thoracic impedance pneumography. One set of measurements was obtained for every patient receiving supplemental oxygen at different flow rates. RESULTS Twenty men, mean (inter-quartile range) age 54 (23-66) yr and BMI 25 (21-31) kg m(-2), were studied. Compared with visual inspection, the bias and limits of agreement were 0.0 (1.0 to -1.0) bpm for the Capnomask(®) and -2.2 (2.0 to -6.5) bpm for the impedance pneumography. The accuracy of respiratory rate assessment using Capnomask(®) was not influenced by the supplemental oxygen flow rate. CONCLUSIONS In extubated patients, continuous assessment of respiratory rate with the Capnomask(®) is more accurate than by thoracic impedance pneumography even when supplemental oxygen is delivered at a high flow rate.
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Affiliation(s)
- A Gaucher
- Service d'Anesthésie-Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.
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Rasera CC, Gewehr PM, Domingues AMT, Junior FF. Measurement of end-tidal carbon dioxide in spontaneously breathing children after cardiac surgery. Am J Crit Care 2011; 20:388-94. [PMID: 21885460 DOI: 10.4037/ajcc2011537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Respiratory monitoring is important after surgery to prevent pulmonary complications. End-tidal carbon dioxide (Petco(2)) measurement by capnometry is an indirect and noninvasive measurement of Pco(2) in blood and is accepted and recognized in critical care. OBJECTIVES To determine the correlation and level of agreement between Petco(2) and Paco(2) in spontaneously breathing children after cardiac surgery and to determine whether Petco(2) measured by using tidal volume (Vt-Petco(2)) or vital capacity (VC-Petco(2)) shows more or less significant correlation with Paco(2). METHODS Vt-Petco(2) and VC-Petco(2) by capnometry and Paco(2) by blood gas analysis were measured once a day after tracheal extubation. The determination coefficient and degree of bias between the methods were assessed in children with and without supplemental oxygen. RESULTS A total of 172 Vt-Petco(2), VC-Petco(2), and Paco(2) values from 48 children were analyzed. The overall coefficients of determination were 0.84 (P < .001) for Vt-Petco(2) and Paco(2) and 0.62 (P = .02) for VC-Petco(2) and Paco(2). The mean gradient for Paco(2) to Petco(2) in all groups increased with the increase in supplemental oxygen; the gradient was significantly larger in the groups given 2 to 5 L of oxygen per minute. CONCLUSIONS In spontaneously breathing children, Vt-Petco(2) provided a more accurate estimate of Paco(2) than did VC-Petco(2), especially in children given little or no supplemental oxygen. The difference between the methods was significantly larger in the groups given 2 to 5 L of oxygen per minute.
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Affiliation(s)
- Carmen Caroline Rasera
- Carmen Caroline Rasera is a cardiopulmonary physiotherapist, and Pedro Miguel Gewehr is a professor of biomedical engineering, Federal University of Technology, Parana, Brazil. Adriana Maria Trevisan Domingues is a functional pneumophysiotherapist in the cardiac intensive care unit and Fernando Faria Junior is a pediatric physician and head of the cardiac intensive care unit, Pequeno Principe Hospital, Parana, Brazil
| | - Pedro Miguel Gewehr
- Carmen Caroline Rasera is a cardiopulmonary physiotherapist, and Pedro Miguel Gewehr is a professor of biomedical engineering, Federal University of Technology, Parana, Brazil. Adriana Maria Trevisan Domingues is a functional pneumophysiotherapist in the cardiac intensive care unit and Fernando Faria Junior is a pediatric physician and head of the cardiac intensive care unit, Pequeno Principe Hospital, Parana, Brazil
| | - Adriana Maria Trevisan Domingues
- Carmen Caroline Rasera is a cardiopulmonary physiotherapist, and Pedro Miguel Gewehr is a professor of biomedical engineering, Federal University of Technology, Parana, Brazil. Adriana Maria Trevisan Domingues is a functional pneumophysiotherapist in the cardiac intensive care unit and Fernando Faria Junior is a pediatric physician and head of the cardiac intensive care unit, Pequeno Principe Hospital, Parana, Brazil
| | - Fernando Faria Junior
- Carmen Caroline Rasera is a cardiopulmonary physiotherapist, and Pedro Miguel Gewehr is a professor of biomedical engineering, Federal University of Technology, Parana, Brazil. Adriana Maria Trevisan Domingues is a functional pneumophysiotherapist in the cardiac intensive care unit and Fernando Faria Junior is a pediatric physician and head of the cardiac intensive care unit, Pequeno Principe Hospital, Parana, Brazil
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Raheem MSA, Wahba OM. A nasal catheter for the measurement of end-tidal carbon dioxide in spontaneously breathing patients: a preliminary evaluation. Anesth Analg 2010; 110:1039-42. [PMID: 20357148 DOI: 10.1213/ane.0b013e3181d365fd] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Several devices have been proposed to monitor end-tidal carbon dioxide tension (Petco(2)) in spontaneously breathing patients; however, many have been reported to be inaccurate. We designed this study to investigate the accuracy of a balloon-tipped nasal catheter in measuring Petco(2) in nontracheally intubated, spontaneously breathing patients. METHODS The catheter was assembled using a 14-F rubber Foley catheter, a tracheal tube pilot balloon, and the plastic sheath from an 18-gauge needle. The catheter was connected to the sampling tube of a gas analyzer. Petco(2) and Paco(2) were determined simultaneously in 20 otherwise healthy postsurgical patients while receiving oxygen. RESULTS The mean Petco(2) - Paco(2) difference was -4.4 +/- 1.6 (SD) mm Hg with a correlation coefficient r = +0.87 (P < 0.001). CONCLUSION Our results suggest that a balloon-tipped nasal catheter can provide a simple, easy, and reliable method for Petco(2) measurement in nontracheally intubated, spontaneously breathing patients.
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Is it safe to use propofol in the emergency department? A randomized controlled trial to compare propofol and midazolam. Int J Emerg Med 2010; 3:105-13. [PMID: 20606819 PMCID: PMC2885259 DOI: 10.1007/s12245-010-0162-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 01/14/2010] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND This study examined the safety and effectiveness of the procedural sedation analgesia (PSA) technique carried out in the emergency department (ED) of a university hospital over a period of 1 year. The research was done to compare the effectiveness and efficacy of moderate sedation of fentanyl combined with either midazolam or propofol for any brief, intense procedure in the ED setting. AIMS The objectives were to observe the occurrence of adverse events in subjects undergoing PSA for intense and painful procedures in the emergency department and to implement the use of capnography as a method of monitoring the patients when they were under PSA. METHODS Forty patients were selected for this study. They were randomly divided into two equal groups using the computer-generated random permuted blocks of four patients. Twenty patients were grouped together as group A and the remaining 20 patients as group B. Drugs used were single blinded to prevent any bias. Drug A was propofol and fentanyl, while drug B was midazolam and fentanyl. The procedures involved included orthopedic manipulation such as reduction of fractures, reduction of dislocated joints, abscess drainage, wound debridement, laceration wound repair and cardioversion. All of the subjects were monitored for their vital signs and end tidal carbon dioxide level every 10 min till the PSA was completed. The duration of stay in the ED was documented when the subjects had completed the procedure and were released from the department. RESULT Of the study population, 75.6% were males. The mean age was 37.8 years (95% CI 33.2, 39.8). None of the patients developed any major complications while under PSA. The vital signs pre-, intra- and post-procedure were not significantly different in either the propofol or mizadolam groups (p value >0.05). CONCLUSION This study had proven that there was no difference in adverse event occurrence between the studied drugs during PSA. Propofol can be recommended for use in PSA if the operator is well trained and familiar with the drug.
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Clinical evaluation of the CapnomaskTM in the supine vs. prone position during monitored anaesthesia care. Eur J Anaesthesiol 2008; 25:769-71. [DOI: 10.1017/s0265021508004134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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