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Transcutaneous carbon dioxide measurements in fruits, vegetables and humans: A prospective observational study. Eur J Anaesthesiol 2020; 36:904-910. [PMID: 31464713 DOI: 10.1097/eja.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Transcutaneous carbon dioxide measurement (TcCO2) is frequently used as a surrogate for arterial blood gas sampling in adults and children with critical illness. Data from noninvasive TcCO2 monitoring assists with clinical decisions regarding mechanical ventilation settings, estimation of metabolic consumption and determination of adequate end-organ tissue perfusion. OBJECTIVES To report TcCO2 values obtained from various fruits, vegetables and elite critical care medicine specialists. DESIGN Prospective, observational, nonblinded cohort study. SETTINGS Single-centre, tertiary paediatric referral centre and organic farmers' market. PARTICIPANTS Vegetables and fruits included 10 samples of each of the following: red delicious apple (Malus domestica), manzano banana (Musa sapientum), key lime (Citrus aurantiifolia), miniature sweet bell pepper (Capsicum annuum), sweet potato (Ipomoea batatas) and avocado (Persea americana). Ten human controls were studied including a paediatric intensivist, a paediatric inpatient hospital physician, four paediatric resident physicians and four paediatric critical care nurses. INTERVENTIONS None. MAIN OUTCOME MEASURES TcCO2 values for each species and device response times. RESULTS TcCO2 readings were measurable in all study species except the sweet potato. Mean ± SD values of TcCO2 for human controls [4.34 ± 0.37 kPa (32.6 ± 2.8 mmHg)] were greater than apples [3.09 ± 0.19 kPa (23.2 ± 1.4 mmHg), P < 0.01], bananas [2.73 ± 0.28 kPa (20.5 ± 2.1 mmHg), P < 0.01] and limes [2.76 ± 0.52 kPa (20.7 ± 3.9 mmHg), P < 0.01] but no different to those of avocados [4.29 ± 0.44 kPa (32.2 ± 3.3 mmHg), P = 0.77] and bell peppers [4.19 ± 1.13 kPa (31.4 ± 8.5 mmHg), P = 0.68]. Transcutaneous response times did not differ between research cohorts and human controls. CONCLUSION We found nonroot, nontuberous vegetables to have TcCO2 values similar to that of healthy, human controls. Fruits yield TcCO2 readings, but substantially lower than human controls.
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Transcutaneous Carbon Dioxide Monitoring During Apnea Testing for Determination of Neurologic Death in Children: A Retrospective Case Series. Pediatr Crit Care Med 2020; 21:437-442. [PMID: 31834253 DOI: 10.1097/pcc.0000000000002225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Determination of neurologic death in children is a clinical diagnosis based on absence of neurologic function with irreversible coma and apnea. Apnea testing during determination of neurologic death assesses spontaneous respiration when PaCO2 increases to greater than or equal to 60 and greater than or equal to 20 mm Hg above pre-apneic baseline. The utility of transcutaneous carbon dioxide measurements during apnea testing in children is unknown. We seek to determine the degree of correlation between paired transcutaneous carbon dioxide and PaCO2 values during apnea testing for determination of neurologic death. DESIGN Single-center, retrospective case series. SETTING Twenty-eight bed PICU in a 259-bed, tertiary care, referral center. PATIENTS Children 0-18 years old undergoing determination of neurologic death between May 2017 and December 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Primary outcomes were paired transcutaneous carbon dioxide and PaCO2 values obtained during determination of neurologic death. Primary analyses included Pearson correlation coefficient, Bland-Altman bias and limits of agreement, and comparative statistics. Descriptive data included demographics, admission diagnoses, hemodynamics, Vasoactive Inotropic Scores, and arterial blood gas measurement. Eight children underwent 15 determination of neurologic death examinations resulting in 31 paired transcutaneous carbon dioxide and PaCO2 values for study. Transcutaneous carbon dioxide and PaCO2 correlated well (r = 0.94; p < 0.01). Bias between transcutaneous carbon dioxide and PaCO2 was -3.29 ± 7.14 mm Hg. Differences in means did not correlate with Vasoactive Inotropic Score (r = 0.2) or patient temperature (r = 0.11). Receiver operator characteristic curve of transcutaneous carbon dioxide after 3-10 minutes of apnea to discriminate positive apnea testing by the standard of PaCO2 yielded an area under the curve of 0.91 and threshold of greater than or equal to 64 mm Hg (sensitivity, 91.7%; specificity, 100%; positive predictive value, 100%; negative predictive value, 92.3%; accuracy, 95.9%). CONCLUSIONS During apnea testing for determination of neurologic death in children, noninvasive transcutaneous carbon dioxide monitoring demonstrated high correlation, accuracy, and minimal bias when compared with PaCO2. Further validation is required before any recommendation to replace PaCO2 with noninvasive transcutaneous carbon dioxide monitoring can be proposed. However, concurrent transcutaneous carbon dioxide data may limit unnecessary apnea time and associated hemodynamic instability or respiratory decompensation by approximating goal arterial blood sampling to document target PaCO2.
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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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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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O'Driscoll BR, Howard LS, Earis J, Mak V. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax 2017; 72:ii1-ii90. [DOI: 10.1136/thoraxjnl-2016-209729] [Citation(s) in RCA: 316] [Impact Index Per Article: 45.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/03/2017] [Accepted: 02/12/2017] [Indexed: 12/15/2022]
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Pilcher J, Eastlake L, Richards M, Power S, Cripps T, Bibby S, Braithwaite I, Weatherall M, Beasley R. Physiological effects of titrated oxygen via nasal high-flow cannulae in COPD exacerbations: A randomized controlled cross-over trial. Respirology 2017; 22:1149-1155. [DOI: 10.1111/resp.13050] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/23/2017] [Accepted: 02/26/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Janine Pilcher
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Clinical Research; Victoria University of Wellington School of Biological Science; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
| | - Leonie Eastlake
- Medical Research Institute of New Zealand; Wellington New Zealand
| | - Michael Richards
- Medical Research Institute of New Zealand; Wellington New Zealand
| | - Sharon Power
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
| | - Terrianne Cripps
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
| | - Susan Bibby
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
| | - Irene Braithwaite
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Clinical Research; Victoria University of Wellington School of Biological Science; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
| | | | - Richard Beasley
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Clinical Research; Victoria University of Wellington School of Biological Science; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
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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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Lermuzeaux M, Meric H, Sauneuf B, Girard S, Normand H, Lofaso F, Terzi N. Superiority of transcutaneous CO2 over end-tidal CO2 measurement for monitoring respiratory failure in nonintubated patients: A pilot study. J Crit Care 2016; 31:150-6. [DOI: 10.1016/j.jcrc.2015.09.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/01/2015] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
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Al-Subu AM, Rehder KJ, Cheifetz IM, Turner DA. Non invasive monitoring in mechanically ventilated pediatric patients. Expert Rev Respir Med 2014; 8:693-702. [PMID: 25119483 DOI: 10.1586/17476348.2014.948856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Cardiopulmonary monitoring is a key component in the evaluation and management of critically ill patients. Clinicians typically rely on a combination of invasive and non-invasive monitoring to assess cardiac output and adequacy of ventilation. Recent technological advances have led to the introduction: of continuous non-invasive monitors that allow for data to be obtained at the bedside of critically ill patients. These advances help to identify hemodynamic changes and allow for interventions before complications occur. In this manuscript, we highlight several important methods of non-invasive cardiopulmonary monitoring, including capnography, transcutaneous monitoring, pulse oximetry, and near infrared spectroscopy.
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Affiliation(s)
- Awni M Al-Subu
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Duke Children's Hospital, Durham, DUMC Box 3046, Durham, NC 27710, NC, USA
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Gates KL, Howell HA, Nair A, Vohwinkel CU, Welch LC, Beitel GJ, Hauser AR, Sznajder JI, Sporn PHS. Hypercapnia impairs lung neutrophil function and increases mortality in murine pseudomonas pneumonia. Am J Respir Cell Mol Biol 2013; 49:821-8. [PMID: 23777386 DOI: 10.1165/rcmb.2012-0487oc] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Hypercapnia, an elevation of the level of carbon dioxide (CO2) in blood and tissues, is a marker of poor prognosis in chronic obstructive pulmonary disease and other pulmonary disorders. We previously reported that hypercapnia inhibits the expression of TNF and IL-6 and phagocytosis in macrophages in vitro. In the present study, we determined the effects of normoxic hypercapnia (10% CO2, 21% O2, and 69% N2) on outcomes of Pseudomonas aeruginosa pneumonia in BALB/c mice and on pulmonary neutrophil function. We found that the mortality of P. aeruginosa pneumonia was increased in 10% CO2-exposed compared with air-exposed mice. Hypercapnia increased pneumonia mortality similarly in mice with acute and chronic respiratory acidosis, indicating an effect unrelated to the degree of acidosis. Exposure to 10% CO2 increased the burden of P. aeruginosa in the lungs, spleen, and liver, but did not alter lung injury attributable to pneumonia. Hypercapnia did not reduce pulmonary neutrophil recruitment during infection, but alveolar neutrophils from 10% CO2-exposed mice phagocytosed fewer bacteria and produced less H2O2 than neutrophils from air-exposed mice. Secretion of IL-6 and TNF in the lungs of 10% CO2-exposed mice was decreased 7 hours, but not 15 hours, after the onset of pneumonia, indicating that hypercapnia inhibited the early cytokine response to infection. The increase in pneumonia mortality caused by elevated CO2 was reversible when hypercapnic mice were returned to breathing air before or immediately after infection. These results suggest that hypercapnia may increase the susceptibility to and/or worsen the outcome of lung infections in patients with severe lung disease.
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Affiliation(s)
- Khalilah L Gates
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine
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Esquinas AM, Lo Coco D. Non-invasive mechanical ventilation and transcutaneous carbon dioxide monitoring in amyotrophic lateral sclerosis: The silent watchdog. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:152-3. [DOI: 10.3109/21678421.2012.760607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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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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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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Wijesinghe M, Perrin K, Healy B, Weatherall M, Beasley R. Randomized controlled trial of high concentration oxygen in suspected community-acquired pneumonia. J R Soc Med 2012; 105:208-16. [PMID: 22532661 DOI: 10.1258/jrsm.2012.110084] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine whether high concentration oxygen increases the PaCO(2) in the treatment of community-acquired pneumonia. DESIGN Randomized controlled clinical trial in which patients received high concentration oxygen (8 L/min via medium concentration mask) or titrated oxygen (to achieve oxygen saturations between 93 and 95%) for 60 minutes. Transcutaneous CO(2) (PtCO(2)) was measured at 0, 20, 40 and 60 minutes. SETTING The Emergency Departments at Wellington, Hutt and Kenepuru Hospitals. PARTICIPANTS 150 patients with suspected community-acquired pneumonia presenting to the Emergency Department. Patients with chronic obstructive pulmonary disease (COPD) or disorders associated with hypercapnic respiratory failure were excluded. MAIN OUTCOME VARIABLES The primary outcome variable was the proportion of patients with a rise in PtCO(2) ≥4 mmHg at 60 minutes. Secondary outcome variables included the proportion of patients with a rise in PtCO(2) ≥8 mmHg at 60 minutes. RESULTS The proportion of patients with a rise in PtCO(2) ≥4 mmHg at 60 minutes was greater in the high concentration oxygen group, 36/72 (50.0%) vs 11/75 (14.7%), relative risk (RR) 3.4 (95% CI 1.9 to 6.2), P < 0.001. The high concentration group had a greater proportion of patients with a rise in PtCO(2) ≥8 mmHg, 11/72 (15.3%) vs 2/75 (2.7%), RR 5.7 (95% CI 1.3 to 25.0), P = 0.007. Amongst the 74 patients with radiological confirmation of pneumonia, the high concentration group had a greater proportion with a rise in PtCO(2) ≥4 mmHg, 20/35 (57.1%) vs 5/39 (12.8%), RR 4.5 (95% CI 1.9 to 10.6) P < 0.001. CONCLUSIONS We conclude that high concentration oxygen therapy increases the PtCO(2) in patients presenting with suspected community-acquired pneumonia. This suggests that the potential increase in PaCO(2) with high concentration oxygen therapy is not limited to COPD, but may also occur in other respiratory disorders with abnormal gas exchange.
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Affiliation(s)
- Meme Wijesinghe
- Medical Research Institute of New Zealand, Wellington 6242, New Zealand
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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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