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Okazawa Y, Kataoka Y, Shindo K. Accuracy of Transcutaneous Carbon Dioxide Measurement During Transcatheter Aortic Valve Replacement Under Monitored Anesthesia Care: A Prospective Observational Study. Cureus 2024; 16:e53661. [PMID: 38455779 PMCID: PMC10917651 DOI: 10.7759/cureus.53661] [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] [Accepted: 02/01/2024] [Indexed: 03/09/2024] Open
Abstract
Background Transcutaneous carbon dioxide tension (PtcCO2) measurement is a promising alternative to arterial carbon dioxide tension (PaCO2) measurement. PaCO2 measurement is invasive and intermittent, whereas PtcCO2 measurement is non-invasive and continuous. However, previous studies evaluating PtcCO2measurements did not include patients undergoing transcatheter aortic valve replacement (TAVR), who experience anticipated hemodynamic changes, particularly before and after valve placement. Therefore, we investigated whether PtcCO2 measurement could provide an alternative to PaCO2 measurement during transfemoral TAVR under monitored anesthesia care (MAC) with local anesthesia. Methodology We conducted a prospective observational study. We included all consecutive patients with severe aortic stenosis who were scheduled to undergo a transfemoral TAVR under MAC at our institution from November 1, 2020, to April 30, 2021. During the procedures, PaCO2 and PtcCO2 were concurrently monitored six times as a reference standard and index test, respectively. PtcCO2 was monitored continuously using a non-invasive earlobe sensor. The agreement between PtcCO2 and PaCO2 measurements was assessed using the Bland-Altman method, and the 95% limits of agreement were calculated. Based on previous studies, we determined that 95% limits of agreement of ±6.0 mmHg would be clinically acceptable to define PtcCO2 as an alternative to PaCO2. Results We obtained 88 measurement pairs from 15 patients. The lower and upper 95% limits of agreement between the PtcCO2 and PaCO2 measurements were -4.22 mmHg and 6.56 mmHg, respectively. Conclusions During TAVR under MAC with local anesthesia, PtcCO2 measurement could not provide a viable alternative to PaCO2 measurement to reduce high PaCO2 events. This study focused on comparing intraoperative periods before and after valve implantation. Therefore, further investigation is warranted to assess the impact of various factors, including the prosthetic valve type and the hemodynamic effects of balloon aortic valvuloplasty, on PtcCO2 measurement in TAVR.
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Affiliation(s)
- Yuki Okazawa
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, JPN
- Department of Anesthesia, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN
| | - Yuki Kataoka
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, JPN
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, JPN
- Department of Systematic Reviewers, Scientific Research Works Peer Support Group, Osaka, JPN
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Kyoto, JPN
| | - Kazuo Shindo
- Department of Anesthesia, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN
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Min SH, Seo JH. Tube or tubeless: an anesthetic strategy for upper airway surgery. Anesth Pain Med (Seoul) 2023; 18:123-131. [PMID: 37183280 PMCID: PMC10183614 DOI: 10.17085/apm.23014] [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: 02/16/2023] [Accepted: 03/15/2023] [Indexed: 05/16/2023] Open
Abstract
Since the patient's airway is shared between an anesthesiologist and a surgeon, airway management during upper airway surgery can be challenging. Beyond the conventional method of general anesthesia, high-flow nasal oxygenation (HFNO) has recently been used as a key technique for tubeless anesthesia. HFNO provides humidified, heated oxygen up to 70 L/min, which promises improved oxygenation and ventilation, allowing for prolonged apneic oxygenation. In previous physiological and clinical studies, HFNO has been demonstrated that tubeless anesthesia safely provide an uninterrupted surgical field during laryngeal surgeries. Although tubeless anesthesia remains uncommon, it can be a good alternative to conventional anesthesia if an anesthesiologist and a surgeon select appropriate patients together with sufficient experience. A safe strategy for tubeless anesthesia, along with appropriate backup plans, including endotracheal intubation and high-frequency jet ventilation, should be considered for upper airway surgery.
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Affiliation(s)
- Se-Hee Min
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Jeong Hwa Seo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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Wang W, Zhao Z, Tian X, Ma X, Xu L, Shang G. Noninvasive carbon dioxide monitoring in pediatric patients undergoing laparoscopic surgery: transcutaneous vs. end-tidal techniques. BMC Pediatr 2023; 23:20. [PMID: 36639787 PMCID: PMC9840246 DOI: 10.1186/s12887-023-03836-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023] Open
Abstract
PURPOSE The present study aimed to investigate the correlation between transcutaneous carbon dioxide partial pressure (PtcCO2) and arterial carbon dioxide pressure (PaCO2) and the accuracy of PtcCO2 in predicting PaCO2 during laparoscopic surgery in pediatric patients. METHODS Children aged 2-8 years with American Society of Anesthesiologists (ASA) class I or II who underwent laparoscopic surgery under general anesthesia were selected. After anesthesia induction and tracheal intubation, PtcCO2 was monitored, and radial arterial catheterization was performed for continuous pressure measurement. PaCO2, PtcCO2, and end-tidal carbon dioxide partial pressure (PetCO2) were measured before pneumoperitoneum, and 30, 60, and 90 min after pneumoperitoneum, respectively. The correlation and agreement between PtcCO2 and PaCO2, PetCO2, and PaCO2 were evaluated. RESULTS A total of 32 patients were eventually enrolled in this study, resulting in 128 datasets. The linear regression equations were: PtcCO2 = 7.89 + 0.82 × PaCO2 (r2 = 0.70, P < 0.01); PetCO2 = 9.87 + 0.64 × PaCO2 (r2 = 0.69, P < 0.01). The 95% limits of agreement (LOA) of PtcCO2 - PaCO2 average was 0.66 ± 4.92 mmHg, and the 95% LOA of PetCO2 - PaCO2 average was -4.4 ± 4.86 mmHg. A difference of ≤ 5 mmHg was noted between PtcCO2 and PaCO2 in 122/128 samples and between PetCO2 and PaCO2 in 81/128 samples (P < 0.01). CONCLUSION In pediatric laparoscopic surgery, a close correlation was established between PtcCO2 and PaCO2. Compared to PetCO2, PtcCO2 can estimate PaCO2 accurately and could be used as an auxiliary monitoring indicator to optimize anesthesia management for laparoscopic surgery in children; however, it is not a substitute for PetCO2. REGISTRATION NUMBER OF CHINESE CLINICAL TRIAL REGISTRY ChiCTR2100043636.
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Affiliation(s)
- Weitao Wang
- grid.452787.b0000 0004 1806 5224Department of Anesthesiology, Shenzhen Children’s Hospital, China Medical University, Shenzhen, China
| | - Zhifa Zhao
- grid.452787.b0000 0004 1806 5224Department of Anesthesiology, Shenzhen Children’s Hospital, China Medical University, Shenzhen, China
| | - Xinjie Tian
- grid.452787.b0000 0004 1806 5224Department of Stomatology, Shenzhen Children’s Hospital, China Medical University, Shenzhen, China
| | - Xinggang Ma
- grid.452787.b0000 0004 1806 5224Department of Anesthesiology, Shenzhen Children’s Hospital, China Medical University, Shenzhen, China
| | - Liang Xu
- grid.452787.b0000 0004 1806 5224Department of Anesthesiology, Shenzhen Children’s Hospital, Shenzhen, China
| | - Guanglin Shang
- grid.452787.b0000 0004 1806 5224Department of Anesthesiology, Shenzhen Children’s Hospital, Shenzhen, China
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Lee HJ, Chae JS, An SM, Oh HW, Kim YJ, Woo JH. Strategy to Reduce Hypercapnia in Robot-Assisted Radical Prostatectomy Using Transcutaneous Carbon Dioxide Monitoring: A Prospective Observational Study. Ther Clin Risk Manag 2022; 18:249-258. [PMID: 35330918 PMCID: PMC8938168 DOI: 10.2147/tcrm.s347690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/07/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Monitoring end-tidal carbon dioxide partial pressure (PETCO2) is a noninvasive, continuous method, but its accuracy is reduced by prolonged capnoperitoneum and the steep Trendelenburg position in robot-assisted radical prostatectomy (RARP). Transcutaneous carbon dioxide partial pressure (PTCCO2) monitoring, which is not affected by ventilator–perfusion mismatch, has been suggested as a suitable alternative. We compared the agreement of noninvasive measurements with the arterial carbon dioxide partial pressure (PaCO2) over a long period of capnoperitoneum, and investigated its sensitivity and predictive power for detecting hypercapnia. Patients and Methods The patients who underwent RARP were enrolled in this study prospectively. Intraoperative measurements of PETCO2, PTCCO2, and PaCO2 were analyzed. The primary outcome was the agreement of noninvasive monitoring with PaCO2 during prolonged capnoperitoneum. Bias and precision between noninvasive measurements and PaCO2 were assessed using Bland–Altman analysis. The bias and mean absolute difference were compared using a two-tailed Wilcoxon signed-rank test for pairs. The secondary outcome was the sensitivity and predictive power for detecting hypercapnia. To assess this, the Yates corrected chi-square test and the area under the receiver operating characteristic curve were used. Results The study analyzed 219 datasets from 46 patients. Compared with PETCO2, PTCCO2 had lower bias, greater precision, and better agreement with PaCO2 throughout the RARP. The mean absolute difference in PETCO2 and PaCO2 was larger than that of PTCCO2 and PaCO2, and continued to exceed the clinically acceptable range of 5 mmHg after 1 hour of capnoperitoneum. The sensitivity during capnoperitoneum and overall predictive power of PTCCO2 for detecting hypercapnia were significantly higher than those of PETCO2, suggesting a greater contribution to ventilator adjustment, to treat hypercapnia. Conclusion PTCCO2 monitoring measured PaCO2 more accurately than PETCO2 monitoring during RARP requiring prolonged capnoperitoneum and a steep Trendelenburg position. PTCCO2 monitoring also provides more sensitive measurements for ventilator adjustment and detects hypercapnia more effectively than PETCO2 monitoring.
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Affiliation(s)
- Hyun Jung Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Ji Seon Chae
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Sang-Mee An
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Hye-Won Oh
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Youn Jin Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jae Hee Woo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
- Correspondence: Jae Hee Woo, Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, 260 Gonghangdaero, Gangseo-gu, Seoul, 07804, South Korea, Tel +82-2-6986-4300, Fax +82-2-6986-4960, Email
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Spyckerelle I, Jonsson Fagerlund M, Holmgren E, Johansson G, Sahlin C, Thunberg J, Franklin KA. Positive Expiratory Pressure Therapy on Oxygen Saturation and Ventilation After Abdominal Surgery: A Randomized Controlled Trial. ANNALS OF SURGERY OPEN 2021; 2:e101. [PMID: 37637885 PMCID: PMC10455159 DOI: 10.1097/as9.0000000000000101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/04/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the immediate effects of positive expiratory pressure therapy on oxygen saturation and ventilation after abdominal surgery. Background Positive expiratory pressure therapy to treat postoperative hypoxia is widespread, despite a lack of evidence of effect. Methods This randomized, sham-controlled, crossover trial investigated adults 1-2 days after abdominal surgery at Umeå University Hospital, Sweden. The intervention was positive expiratory pressure of 10-15 cm H2O. The control was a sham device. The investigations were ended with deep-breathing maneuvers. Outcomes were the gradient of changes in peripheral oxygen saturation and transcutaneous carbon-dioxide partial pressure (PtcCO2). Results Eighty patients were included and randomized and 76 patients were analyzed. Oxygen saturation increased from a baseline mean of 92% to 95%, P < 0.001, during positive expiratory pressure breathing, while PtcCO2 decreased from a mean of 36 to 33 mm Hg, P < 0.001. This was followed by apnea, oxygen desaturations to a mean of 89%, P < 0.001, and increased PtcCO2 before returning to baseline values. The changes in oxygen saturation and PtcCO2 did not differ from sham breathing or deep-breathing maneuvers. Conclusions Positive expiratory pressure breathing after abdominal surgery improves oxygen saturation during the maneuver because of hyperventilation, but it is followed by apnea, hypoventilation, and oxygen desaturation. The effect is not different from the expiration to a sham device or hyperventilation. It is time to stop positive expiratory pressure therapy after abdominal surgery, as there is no evidence of effect in previous trials, apart from the adverse effects reported here.
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Affiliation(s)
- Iris Spyckerelle
- From the Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Malin Jonsson Fagerlund
- Perioperative Medicine and Intensive Care Medicine and Department of Physiology and Pharmacology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Erik Holmgren
- From the Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Göran Johansson
- Department of Surgical and Perioperative Sciences, Anesthesiology, Umeå University, Umeå, Sweden
| | - Carin Sahlin
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | - Johan Thunberg
- Department of Surgical and Perioperative Sciences, Anesthesiology, Umeå University, Umeå, Sweden
| | - Karl A. Franklin
- From the Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Abdel-Ghaffar HS, Bakr MAM, Osman MAK, Hanna SGL, Ali WN. End-tidal carbon dioxide measurements as a surrogate to arterial carbon dioxide during pediatric laparoscopic surgeries: a prospective observational cohort study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2021:S0104-0014(21)00326-2. [PMID: 34411630 DOI: 10.1016/j.bjane.2021.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Maintaining normocapnia during mechanical ventilation in anesthetized children during laparoscopic surgeries is highly recommended. There is a debate regarding the use of capnography (ETCO2) as a trend monitor for evaluation of arterial carbon dioxide levels (PaCO2). We analyzed the relationship between ETCO2 and PaCO2 with time in elective pediatric laparoscopic surgeries. METHODS This study was a prospective observational cohort analysis of 116 paired comparisons between PaCO2 and ETCO2 computed from 29 children (ASA I, 12-72 months). Arterial blood samples were withdrawn before, at 15 minutes and 30 minutes during pneumoperitoneum and 1 minute after deflation. ETCO2 value was recorded simultaneously, while arterial blood was withdrawn. PaCO2-ETCO2 relationship was evaluated by Pearson's correlation coefficients and Bland Altman Method of agreement. RESULTS Out of the 116 comparisons analyzed, a PaCO2-ETCO2 difference beyond 0 to ≤ 5 mmHg was recorded in 71 comparisons (61.2%) with negative difference in 34 comparisons (29.3%). A positive significant correlation between PaCO2 and ETCO2 was recorded before (r = 0.617, p = 0.000) and at 15 minutes (r = 0.582, p = 0.001), with no significant correlation at 30 minutes (r = 0.142, p = 0.461), either after deflation (r = 0.108, p = 0.577). Bland-Altman plots showed agreement between ETCO2 and PaCO2 before inflation with mean PaCO2-ETCO2 difference 0.14 ± 5.6 mmHg (limits of 95% agreement -10.84-11.2, simple linear regression testing p-value 0.971), with no agreement at 15 minutes (0.51 ± 7.15, -13.5-14.5, p = 0.000), 30 minutes. (2.62 ± 7.83, -12.73-17.97, p = 0.000), or after deflation (1.81 ± 6.56, -10.93-14.55, p = 0.015). CONCLUSION Usage of capnography as a trend monitor in pediatric laparoscopic surgeries may not be a reliable surrogate for PaCO2 levels. TRIAL REGISTRATION Clinical Trials. gov (Identifier: NCT03361657).
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Affiliation(s)
- Hala Saad Abdel-Ghaffar
- Assiut University, Faculty of Medicine, Anesthesia and Intensive Care Department, Assiut, Egypt.
| | | | | | | | - Wesam Nashat Ali
- Assiut University, Faculty of Medicine, Anesthesia and Intensive Care Department, Assiut, Egypt
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Bauchat JR, McCarthy R, Fitzgerald P, Kolb S, Wong CA. Transcutaneous Carbon Dioxide Measurements in Women Receiving Intrathecal Morphine for Cesarean Delivery: A Prospective Observational Study. Anesth Analg 2017; 124:872-878. [PMID: 28099291 DOI: 10.1213/ane.0000000000001751] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Neuraxial morphine is the most commonly used analgesic technique after cesarean delivery. The incidence of respiratory depression is reported to be very low (0%-1.2%) in this patient population as measured by pulse oximetry and respiratory rates. However, hypercapnia may be a more sensitive measure of respiratory depression. In the current study, the incidence of hypercapnia events (transcutaneous CO2 [TcCO2] >50 mm Hg) for ≥2-minute duration was evaluated using the Topological Oscillation Search with Kinematical Analysis monitor in women who received intrathecal morphine for postcesarean delivery analgesia. METHODS Healthy women (>37 weeks of gestation) scheduled for a cesarean delivery with spinal anesthesia with intrathecal morphine were recruited. Baseline STOP-BANG sleep apnea questionnaire and TcCO2 readings were obtained. Spinal anesthesia was initiated with 12 mg hyperbaric bupivacaine, 15 µg fentanyl, and 150 µg morphine. The Topological Oscillation Search with Kinematical Analysis monitor was reapplied in the postanesthesia care unit and TcCO2 measurements obtained for up to 24 hours. Supplemental opioid administration and adverse respiratory events were recorded. The primary outcome was the incidence of hypercapnia events, defined as a TcCO2 reading >50 mm Hg for ≥2 minutes in the first 24 hours after delivery. RESULTS Of the 120 women who were recruited, 108 completed the study. Thirty-five women (32%; 99.15% confidence interval, 21%-45%) reached the primary outcome of a sustained hypercapnia event. The median time (interquartile range [IQR]) from intrathecal morphine administration to the hypercapnia event was 300 (124-691) minutes. The median (IQR) number of events was 3 (1-6) and longest duration of an event was 25.6 (8.4-98.7) minutes. Baseline median (IQR) TcCO2 measurements were 35 (30-0) mm Hg and postoperatively, median (IQR) TcCO2 measurements were 40 (36-43) mm Hg, a difference of 5 mm Hg (99.15% confidence interval of the difference 2-8 mm Hg, P < .001). The incidence of hypercapnia events was 5.4% in women with a baseline TcCO2 value ≤31 mm Hg, 22.5% with a baseline TcCO2 between 32 and 38 mm Hg, and 77.4% with a baseline TcCO2 >38 mm Hg (P < .001). CONCLUSIONS Hypercapnia events (>50 mm Hg for ≥2-minute duration) occurred frequently in women receiving 150 μg intrathecal morphine for postcesarean analgesia. Higher baseline TcCO2 readings were observed in women who had hypercapnia events.
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Affiliation(s)
- Jeanette R Bauchat
- From the *Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and †Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa
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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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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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Liu S, Sun J, Chen X, Yu Y, Liu X, Liu C. The application of transcutaneous CO2 pressure monitoring in the anesthesia of obese patients undergoing laparoscopic bariatric surgery. PLoS One 2014; 9:e91563. [PMID: 24699267 PMCID: PMC3974655 DOI: 10.1371/journal.pone.0091563] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 02/12/2014] [Indexed: 11/18/2022] Open
Abstract
To investigate the correlation and accuracy of transcutaneous carbon dioxide partial pressure (PTCCO2) with regard to arterial carbon dioxide partial pressure (PaCO2) in severe obese patients undergoing laparoscopic bariatric surgery. Twenty-one patients with BMI>35 kg/m(2) were enrolled in our study. Their PaCO2, end-tidal carbon dioxide partial pressure (PetCO2), as well as PTCCO2 values were measured at before pneumoperitoneum and 30 min, 60 min, 120 min after pneumoperitoneum respectively. Then the differences between each pair of values (PetCO2-PaCO2) and. (PTCCO2-PaCO2) were calculated. Bland-Altman method, correlation and regression analysis, as well as exact probability method and two way contingency table were employed for the data analysis. 21 adults (aged 19-54 yr, mean 29, SD 9 yr; weight 86-160 kg, mean 119.3, SD 22.1 kg; BMI 35.3-51.1 kg/m(2), mean 42.1,SD 5.4 kg/m(2)) were finally included in this study. One patient was eliminated due to the use of vaso-excitor material phenylephrine during anesthesia induction. Eighty-four sample sets were obtained. The average PaCO2-PTCCO2 difference was 0.9 ± 1.3 mmHg (mean ± SD). And the average PaCO2-PetCO2 difference was 10.3 ± 2.3 mmHg (mean ± SD). The linear regression equation of PaCO2-PetCO2 is PetCO2 = 11.58+0.57 × PaCO2 (r(2) = 0.64, P<0.01), whereas the one of PaCO2-PTCCO2 is PTCCO2 = 0.60 + 0.97 × PaCO2 (r(2) = 0.89). The LOA (limits of agreement) of 95% average PaCO2-PetCO2 difference is 10.3 ± 4.6 mmHg (mean ± 1.96 SD), while the LOA of 95% average PaCO2-PTCCO2 difference is 0.9 ± 2.6 mmHg (mean ± 1.96 SD). In conclusion, transcutaneous carbon dioxide monitoring provides a better estimate of PaCO2 than PetCO2 in severe obese patients undergoing laparoscopic bariatric surgery.
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Affiliation(s)
- Shijiang Liu
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Sun
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xing Chen
- Department of Project Management, Jiangsu New Energy Development Company, Jiangsu Guoxin Investment Group, Nanjing, China
| | - Yingying Yu
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xuan Liu
- Department of Anesthesiology, General Hospital of TISCO, TaiYuan, China
| | - Cunming Liu
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- * E-mail:
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Transcutaneous CO2 plateau as set-point for respiratory drive during upper airway flow-limitation. Respir Physiol Neurobiol 2014; 191:44-51. [DOI: 10.1016/j.resp.2013.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 10/23/2013] [Accepted: 10/28/2013] [Indexed: 11/21/2022]
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A comparison of the incidence of hypercapnea in non-obese and morbidly obese peri-operative patients using the SenTec transcutaneous pCO2 monitor. J Clin Monit Comput 2013; 28:293-8. [DOI: 10.1007/s10877-013-9534-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 11/15/2013] [Indexed: 11/26/2022]
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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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Barter LS, Hopper K. Transcutaneous monitor approximates PaCO(2) but not PaO(2) in anesthetized rabbits. Vet Anaesth Analg 2011; 38:568-75. [PMID: 21988811 DOI: 10.1111/j.1467-2995.2011.00662.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the accuracy of transcutaneous (tc) to arterial partial pressure of carbon dioxide (PaCO(2) ) and partial pressure of oxygen (PaO(2) ) in anesthetized rabbits. STUDY DESIGN Prospective, randomized, experimental study. ANIMALS Eight healthy adult female New Zealand white rabbits weighing 4.05± 0.30 kg. METHODS Isoflurane anesthetized rabbits received six treatments in random order; PaCO(2) <35, 35-45, and >45 mmHg and PaO(2) < 80, 100-200, >200 mmHg. Arterial and transcutaneous measurements were taken after 15 minutes of stabilization at each condition. Linear regression, correlation and Bland-Altman analysis were performed to compare PtcCO(2) to PaCO(2) and PtcO(2) to PaO(2) . RESULTS Over a range of measured PaCO(2) values from 21 to 67 mmHg (n=24) mean bias for PtcCO(2) was -1 mmHg and the 95% limits of agreement were -7 to 5 mmHg. The correlation between PtcCO(2) and PaCO(2) was strong with R(2) value of 0.9454. Over the entire range of measured PaO(2) values (46-508 mmHg) mean bias for PtcO(2) was -61 mmHg and the 95% limits of agreement were -226 to 104 mmHg. Correlation was poor with R(2) =0.5969. Comparing PtcO(2) to PaO(2) over a narrower range [PaO(2) < 150 mmHg (n=13)] improved the correlation, with an R(2) value of 0.8518, mean bias of -7 mmHg and 95% limits of agreement from -33 to 19 mmHg. CONCLUSIONS AND CLINICAL RELEVANCE In healthy anesthetized rabbits, PtcCO(2) closely approximated PaCO(2) . In contrast PtcO(2) underestimated PaO(2) , particularly at high values. The PtcCO(2) sensor may be a useful noninvasive way to assess adequacy of ventilation in anesthetized rabbits.
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Affiliation(s)
- Linda S Barter
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA.
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Kelly AM, Klim S. Agreement between arterial and transcutaneous PCO2 in patients undergoing non-invasive ventilation. Respir Med 2010; 105:226-9. [PMID: 21131188 DOI: 10.1016/j.rmed.2010.11.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 10/06/2010] [Accepted: 11/12/2010] [Indexed: 11/27/2022]
Abstract
AIM Transcutaneous carbon dioxide (PtCO(2)) monitoring offers a potentially non-invasive and continuous means to determine the arterial carbon dioxide tension (PaCO(2)). ED studies of agreement between PtCO(2) and PaCO(2) have had conflicting findings and have not been targeted to subgroups with severe ventilatory disturbance such as those requiring non-invasive ventilation [NIV]. Our aim is to determine agreement between PtCO(2) and PaCO(2) for patients undergoing NIV for respiratory failure. METHODS This prospective observational study included a convenience sample of patients undergoing NIV for respiratory failure who required arterial blood gas analysis as part of their care. Data collected included patient demographics, indication for NIV, diagnosis, vital signs, and pH, PaCO(2) and PtCO(2). The outcome of interest was agreement between PaCO(2) and PtCO(2). Analysis was made using descriptive statistics, Bland-Altman techniques, Mann-Whitney U test and Fisher/Chi square tests. RESULTS 46 comparisons were analysed. Median age was 69 [IQR 65-79], 67% male; median PaCO(2) 60 mmHg [IQR 46-70] and median pH 7.35 [IQR 7.30-7.38]. Average difference between PaCO(2) and PtCO(2) was 6.1 mmHg with 95% limits of agreement -10.1-22.3 mmHg. Thirty seven comparisons [80%] were within 10 mmHg [95% CI 66-90%]. Difference >10 mmHg was associated with increasing PaCO(2) [p = 0.001; median difference 19.6 mmHg, 95% CI 9.2-30.4 mmHg]. All cases with difference >10 mmHg had PaCO(2) > 60 mmHg. CONCLUSION In patients undergoing NIV, agreement between PaCO(2) and PtCO(2) was sub-optimal, with unacceptably wide 95% limits of agreement. PtCO(2) cannot be recommended as a substitute for PaCO(2) testing in this group.
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Affiliation(s)
- Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research at Western Health and The University of Melbourne, Australia.
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