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Bernasconi S, Angelucci A, De Cesari A, Masotti A, Pandocchi M, Vacca F, Zhao X, Paganelli C, Aliverti A. Recent Technologies for Transcutaneous Oxygen and Carbon Dioxide Monitoring. Diagnostics (Basel) 2024; 14:785. [PMID: 38667431 PMCID: PMC11049249 DOI: 10.3390/diagnostics14080785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
The measurement of partial pressures of oxygen (O2) and carbon dioxide (CO2) is fundamental for evaluating a patient's conditions in clinical practice. There are many ways to retrieve O2/CO2 partial pressures and concentrations. Arterial blood gas (ABG) analysis is the gold standard technique for such a purpose, but it is invasive, intermittent, and potentially painful. Among all the alternative methods for gas monitoring, non-invasive transcutaneous O2 and CO2 monitoring has been emerging since the 1970s, being able to overcome the main drawbacks of ABG analysis. Clark and Severinghaus electrodes enabled the breakthrough for transcutaneous O2 and CO2 monitoring, respectively, and in the last twenty years, many innovations have been introduced as alternatives to overcome their limitations. This review reports the most recent solutions for transcutaneous O2 and CO2 monitoring, with a particular consideration for wearable measurement systems. Luminescence-based electronic paramagnetic resonance and photoacoustic sensors are investigated. Optical sensors appear to be the most promising, giving fast and accurate measurements without the need for frequent calibrations and being suitable for integration into wearable measurement systems.
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2
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Dervieux E, Guerrero F, Uhring W, Giroux-Metgès MA, Théron M. Skin temperature influence on transcutaneous carbon dioxide (CO 2) conductivity and skin blood flow in healthy human subjects at the arm and wrist. Front Physiol 2024; 14:1293752. [PMID: 38321986 PMCID: PMC10846589 DOI: 10.3389/fphys.2023.1293752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/05/2023] [Indexed: 02/08/2024] Open
Abstract
Objective: present transcutaneous carbon dioxide (CO2)-tcpCO2-monitors suffer from limitations which hamper their widespread use, and call for a new tcpCO2 measurement technique. However, the progress in this area is hindered by the lack of knowledge in transcutaneous CO2 diffusion. To address this knowledge gap, this study focuses on investigating the influence of skin temperature on two key skin properties: CO2 permeability and skin blood flow. Methods: a monocentric prospective exploratory study including 40 healthy adults was undertaken. Each subject experienced a 90 min visit split into five 18 min sessions at different skin temperatures-Non-Heated (NH), 35, 38, 41, and 44°C. At each temperature, custom sensors measured transcutaneous CO2 conductivity and exhalation rate at the arm and wrist, while Laser Doppler Flowmetry (LDF) assessed skin blood flow at the arm. Results: the three studied metrics sharply increased with rising skin temperature. Mean values increased from the NH situation up to 44°C from 4.03 up to 8.88 and from 2.94 up to 8.11 m·s-1 for skin conductivity, and from 80.4 up to 177.5 and from 58.7 up to 162.3 cm3·m-2·h-1 for exhalation rate at the arm and wrist, respectively. Likewise, skin blood flow increased elevenfold for the same temperature increase. Of note, all metrics already augmented significantly in the 35-38°C skin temperature range, which may be reached without active heating-i.e. only using a warm clothing. Conclusion: these results are extremely encouraging for the development of next-generation tcpCO2 sensors. Indeed, the moderate increase (× 2) in skin conductivity from NH to 44°C tends to indicate that heating the skin is not critical from a response time point of view, i.e. little to no skin heating would only result in a doubled sensor response time in the worst case, compared to a maximal heating at 44°C. Crucially, a skin temperature within the 35-38°C range already sharply increases the skin blood flow, suggesting that tcpCO2 correlates well with the arterial paCO2 even at such low skin temperatures. These two conclusions further strengthen the viability of non-heated tcpCO2 sensors, thereby paving the way for the development of wearable transcutaneous capnometers.
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Affiliation(s)
- Emmanuel Dervieux
- Biosency, Cesson-Sévigné, France
- EA4324-ORPHY, Univ Brest, Brest, France
- ICube, University of Strasbourg and CNRS, Strasbourg, France
| | | | - Wilfried Uhring
- ICube, University of Strasbourg and CNRS, Strasbourg, France
| | - Marie-Agnès Giroux-Metgès
- EA4324-ORPHY, Univ Brest, Brest, France
- Explorations Fonctionnelles Respiratoires, Centre Hospitalier Régional et Universitaire de Brest, Brest, France
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3
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Abstract
Hypercapnia is commonly encountered by general and specialist respiratory clinicians. Patients at risk of developing hypercapnic respiratory failure include those with chronic obstructive pulmonary disease (COPD), obesity and neuromuscular disease. Such patients may present to clinicians acutely unwell on the acute medical take or during an inpatient deterioration, or be identified in the stable outpatient setting. In this review, we provide a practical guide to develop clinicians' knowledge, skills and confidence in promptly recognising and managing hypercapnic respiratory failure, and to promote national ventilation quality standards to encourage consistent delivery of high-quality care and optimise outcomes for patients.
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Affiliation(s)
- Laura Tregidgo
- Lane Fox Respiratory Unit, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Rebecca F D'Cruz
- Lane Fox Respiratory Unit, Guys and St Thomas' NHS Foundation Trust, London, UK; Centre for Human and Applied Physiological Sciences, King's College London, London, UK.
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Kindermans M, Joachim J, Manquat E, Levé C, Hong A, Mateo J, Mebazaa A, Gayat E, De Backer D, Vallée F. Micro- and macrocirculatory effects of norepinephrine on anaesthesia-induced hypotension: a prospective preliminary study. BMC Anesthesiol 2023; 23:374. [PMID: 37974084 PMCID: PMC10652607 DOI: 10.1186/s12871-023-02342-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Intraoperative arterial hypotension (IOH) leads to increased postoperative morbidity. Norepinephrine is often use to treat IOH. The question regarding the mode of administration in either a bolus or continuous infusion remains unanswered. The aim of the present study was to describe and compare the effects on macrocirculation and microcirculation of a bolus and a continuous infusion of norepinephrine to treat IOH. METHODS We conducted a prospective observational study with adult patients who underwent neurosurgery. Patients with invasive arterial blood pressure and cardiac output (CO) monitoring were screened for inclusion. All patients underwent microcirculation monitoring by video-capillaroscopy, laser doppler, near-infrared spectroscopy technology, and tissular CO2. In case of IOH, the patient could receive either a bolus of 10 µg or a continuous infusion of 200 µg/h of norepinephrine. Time analysis for comparison between bolus and continuous infusion were at peak of MAP. The primary outcome was MFI by videocapillaroscopy. RESULTS Thirty-five patients were included, with 41 boluses and 33 continuous infusion. Bolus and continuous infusion induced an maximal increase in mean arterial pressure of +30[20-45] and +23[12-34] %, respectively (P=0,07). For macrocirculatory parameters, continuous infusion was associated with a smaller decrease in CO and stroke volume (p<0.05). For microcirculatory parameters, microvascular flow index (-0,1 vs. + 0,3, p=0,03), perfusion index (-12 vs. +12%, p=0,008), total vessel density (-0,2 vs. +2,3 mm2/mm2, p=0,002), showed significant opposite variations with bolus and continuous infusion, respectively. CONCLUSIONS These results on macro and microcirculation enlighten the potential benefits of a continuous infusion of norepinephrine rather than a bolus to treat anaesthesia-induced hypotension. TRIAL REGISTRATION (NOR-PHARM: 1-17-42 Clinical Trials: NCT03454204), 05/03/2018.
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Affiliation(s)
- Manuel Kindermans
- Department of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, 02 rue Ambroise Paré, 75010, Paris, France.
| | - Jona Joachim
- Department of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, 02 rue Ambroise Paré, 75010, Paris, France
- Inserm, UMRS-942, Paris Diderot University, 02, rue Ambroise Paré, 75010, Paris, France
| | - Elsa Manquat
- Department of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, 02 rue Ambroise Paré, 75010, Paris, France
- Inserm, UMRS-942, Paris Diderot University, 02, rue Ambroise Paré, 75010, Paris, France
| | - Charlotte Levé
- Department of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, 02 rue Ambroise Paré, 75010, Paris, France
| | - Alex Hong
- Department of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, 02 rue Ambroise Paré, 75010, Paris, France
| | - Joachim Mateo
- Department of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, 02 rue Ambroise Paré, 75010, Paris, France
| | - Alexandre Mebazaa
- Department of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, 02 rue Ambroise Paré, 75010, Paris, France
- Inserm, UMRS-942, Paris Diderot University, 02, rue Ambroise Paré, 75010, Paris, France
| | - Etienne Gayat
- Department of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, 02 rue Ambroise Paré, 75010, Paris, France
- Inserm, UMRS-942, Paris Diderot University, 02, rue Ambroise Paré, 75010, Paris, France
| | - Daniel De Backer
- CHIREC, Brussels, Belgium
- Intensive Care Department, CHIREC Hospitals, Brussels, Belgium
| | - Fabrice Vallée
- Department of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis Hospitals, 02 rue Ambroise Paré, 75010, Paris, France
- Inserm, UMRS-942, Paris Diderot University, 02, rue Ambroise Paré, 75010, Paris, France
- Inria Saclay Ile-de-France, Palaiseau, France
- LMS, École Polytechnique, CNRS, Paris, France
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5
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Roshdy A. Respiratory Monitoring During Mechanical Ventilation: The Present and the Future. J Intensive Care Med 2023; 38:407-417. [PMID: 36734248 DOI: 10.1177/08850666231153371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The increased application of mechanical ventilation, the recognition of its harms and the interest in individualization raised the need for an effective monitoring. An increasing number of monitoring tools and modalities were introduced over the past 2 decades with growing insight into asynchrony, lung and chest wall mechanics, respiratory effort and drive. They should be used in a complementary rather than a standalone way. A sound strategy can guide a reduction in adverse effects like ventilator-induced lung injury, ventilator-induced diaphragm dysfunction, patient-ventilator asynchrony and helps early weaning from the ventilator. However, the diversity, complexity, lack of expertise, and associated cost make formulating the appropriate monitoring strategy a challenge for clinicians. Most often, a big amount of data is fed to the clinicians making interpretation difficult. Therefore, it is fundamental for intensivists to be aware of the principle, advantages, and limits of each tool. This analytic review includes a simplified narrative of the commonly used basic and advanced respiratory monitors along with their limits and future prospective.
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Affiliation(s)
- Ashraf Roshdy
- Critical Care Medicine Department, Faculty of Medicine, 54562Alexandria University, Alexandria, Egypt.,Critical Care Unit, North Middlesex University Hospital, London, UK
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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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Strowitzki MJ, Nelson R, Garcia MP, Tuffs C, Bleul MB, Fitzsimons S, Navas J, Uzieliene I, Ritter AS, Phelan D, Kierans SJ, Blanco A, Bernotiene E, Belton O, Schneider M, Cummins EP, Taylor CT. Carbon Dioxide Sensing by Immune Cells Occurs through Carbonic Anhydrase 2-Dependent Changes in Intracellular pH. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 208:2363-2375. [PMID: 35477686 DOI: 10.4049/jimmunol.2100665] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
CO2, the primary gaseous product of respiration, is a major physiologic gas, the biology of which is poorly understood. Elevated CO2 is a feature of the microenvironment in multiple inflammatory diseases that suppresses immune cell activity. However, little is known about the CO2-sensing mechanisms and downstream pathways involved. We found that elevated CO2 correlates with reduced monocyte and macrophage migration in patients undergoing gastrointestinal surgery and that elevated CO2 reduces migration in vitro. Mechanistically, CO2 reduces autocrine inflammatory gene expression, thereby inhibiting macrophage activation in a manner dependent on decreased intracellular pH. Pharmacologic or genetic inhibition of carbonic anhydrases (CAs) uncouples a CO2-elicited intracellular pH response and attenuates CO2 sensitivity in immune cells. Conversely, CRISPR-driven upregulation of the isoenzyme CA2 confers CO2 sensitivity in nonimmune cells. Of interest, we found that patients with chronic lung diseases associated with elevated systemic CO2 (hypercapnia) display a greater risk of developing anastomotic leakage following gastrointestinal surgery, indicating impaired wound healing. Furthermore, low intraoperative pH levels in these patients correlate with reduced intestinal macrophage infiltration. In conclusion, CO2 is an immunomodulatory gas sensed by immune cells through a CA2-coupled change in intracellular pH.
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Affiliation(s)
- Moritz J Strowitzki
- School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin, Ireland
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Ross Nelson
- School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin, Ireland
| | - Mario P Garcia
- School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin, Ireland
| | - Christopher Tuffs
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Marc B Bleul
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Stephen Fitzsimons
- Diabetes Complications Research Centre, School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Belfield, Dublin, Ireland; and
| | - Javier Navas
- School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin, Ireland
| | - Ilona Uzieliene
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Alina S Ritter
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - David Phelan
- School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin, Ireland
| | - Sarah J Kierans
- School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin, Ireland
| | - Alfonso Blanco
- School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin, Ireland
| | - Eiva Bernotiene
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Orina Belton
- Diabetes Complications Research Centre, School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Belfield, Dublin, Ireland; and
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Eoin P Cummins
- School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin, Ireland
| | - Cormac T Taylor
- School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin, Ireland;
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Werther T, Aichhorn L, Stellberg S, Cardona FS, Klebermass-Schrehof K, Berger A, Schmölzer GM, Wagner M. Monitoring of carbon dioxide in ventilated neonates: a prospective observational study. Arch Dis Child Fetal Neonatal Ed 2022; 107:293-298. [PMID: 34344835 DOI: 10.1136/archdischild-2021-322138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/19/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the reliability, accuracy and precision of distal end-tidal capnography (detCO2) in neonates compared with transcutaneous (tcCO2) carbon dioxide measurements. DESIGN Observational, prospective clinical study. SETTING Neonatal intensive care unit at Medical University of Vienna. PARTICIPANTS Conventionally ventilated neonates with a body weight between 1000 g and 3000 g. INTERVENTION End-tidal partial pressure of CO2 was measured in distal position using the separate lumen of a double-lumen endotracheal tube connected to an external side-stream capnometer. Three consecutive detCO2 and tcCO2 values were recorded simultaneously and compared with simultaneous arterialised partial pressure of CO2 (paCO2) measurements in each patient. MAIN OUTCOME MEASURES Reliability, accuracy and precision of detCO2 and tcCO2 measurements compared with paCO2 in neonates. RESULTS Twenty-five neonates were included with a median (range) weight at enrolment of 1410 (1010-2980) g, from which 81 simultaneous measurements of detCO2, tcCO2 and paCO2 were obtained. The mean (SD) of paCO2, detCO2 and tcCO2 was 45.0 (8.6) mmHg, 42.4 (8.4) mmHg and 50.4 (20.4) mmHg, respectively. The intraclass correlation between paCO2 and detCO2 and between paCO2 and tcCO2 reached 0.80 (95% CI 0.71 to 0.87, p<0.001) and 0.59 (95% CI 0.43 to 0.72, p<0.001), respectively. In the Bland-Altman analysis, bias and precision of detCO2 with respect to paCO2 amounted to -2.68 mmHg and 10.62 mmHg (95% CI 8.49 to 14.51), respectively. Bias and precision of tcCO2 with respect to paCO2 amounted to 5.39 mmHg and 17.22 mmHg (95% CI 13.21 to 23.34), respectively. CONCLUSION DetCO2 had better reliability, accuracy and precision with paCO2 than tcCO2 in ventilated neonates without severe lung diseas. TRIAL REGISTRATION NUMBER NCT03758313.
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Affiliation(s)
- Tobias Werther
- Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Lukas Aichhorn
- Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Sina Stellberg
- Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Francesco Stefano Cardona
- Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Georg M Schmölzer
- Department of Pediatrics, Division of Neonatology, University of Alberta, Edmonton, Alberta, Canada.,Centre for the Studies of Asphyxia and Resuscitation, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Wagner
- Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Dervieux E, Théron M, Uhring W. Carbon Dioxide Sensing-Biomedical Applications to Human Subjects. SENSORS (BASEL, SWITZERLAND) 2021; 22:188. [PMID: 35009731 PMCID: PMC8749784 DOI: 10.3390/s22010188] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 02/06/2023]
Abstract
Carbon dioxide (CO2) monitoring in human subjects is of crucial importance in medical practice. Transcutaneous monitors based on the Stow-Severinghaus electrode make a good alternative to the painful and risky arterial "blood gases" sampling. Yet, such monitors are not only expensive, but also bulky and continuously drifting, requiring frequent recalibrations by trained medical staff. Aiming at finding alternatives, the full panel of CO2 measurement techniques is thoroughly reviewed. The physicochemical working principle of each sensing technique is given, as well as some typical merit criteria, advantages, and drawbacks. An overview of the main CO2 monitoring methods and sites routinely used in clinical practice is also provided, revealing their constraints and specificities. The reviewed CO2 sensing techniques are then evaluated in view of the latter clinical constraints and transcutaneous sensing coupled to a dye-based fluorescence CO2 sensing seems to offer the best potential for the development of a future non-invasive clinical CO2 monitor.
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Affiliation(s)
- Emmanuel Dervieux
- BiOSENCY, 1137a Avenue des Champs Blancs, 35510 Cesson-Sévigné, France
| | - Michaël Théron
- ORPHY, Université de Bretagne Occidentale, 6 Avenue Victor le Gorgeu, 29238 Brest, France;
| | - Wilfried Uhring
- ICube, University of Strasbourg and CNRS, 23 rue du Loess, CEDEX, 67037 Strasbourg, France;
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10
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Tian C, Hawryluck L, Tomlinson G, Chung F, Beattie S, Miller M, Hassan N, Wong DT, Wong J, Hudson J, Jackson T, Singh M. Impact of a continuous enhanced cardio-respiratory monitoring pathway on cardio-respiratory complications after bariatric surgery: A retrospective cohort study. J Clin Anesth 2021; 77:110639. [PMID: 34953279 DOI: 10.1016/j.jclinane.2021.110639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE To determine the impact of an enhanced monitoring pathway consisting of continuous postoperative cardio-respiratory monitoring on adverse outcomes after bariatric. DESIGN Single-center, retrospective cohort study. PATIENTS Adult patients who underwent bariatric surgeries between 2009 and 2016. INTERVENTIONS We evaluated the use of an enhanced monitoring pathway consisting of a distant, continuous, non-invasive respiratory monitoring system on postoperative cardio-respiratory complications in patients undergoing bariatric surgery. Treating physicians had the option to assign patients to enhanced monitoring (intervention group) in the postoperative period for suspected or diagnosed OSA or other clinical concerns. The control group had intermittent vital sign checks as per institutional standards. MEASUREMENTS The primary outcome was a composite of cardio-respiratory complications (rapid response team activation, intensive care admission, respiratory complications), major adverse cardiac events, and all-cause mortality. The secondary outcome was length of stay (LOS). MAIN RESULTS Of 1450 patients, 752 patients received enhanced monitoring (intervention) and 698 patients received standard monitoring (control). Univariate analysis showed that, compared to control, enhanced monitoring was associated with lower odds of composite cardio-respiratory complications (OR: 0.41, 95%CI: 0.32-0.53, p < 0.001) and lower odds of prolonged LOS > 2 days (OR: 0.37, 95% CI: 0.28-0.49, p < 0.001. After adjusting for potential confounders, enhanced monitoring remained associated with a reduction in composite cardio-respiratory complications (OR: 0.64, 95% CI: 0.46-0.88, p = 0.005). CONCLUSIONS Our study demonstrates that postoperative enhanced monitoring pathway was associated with a lower incidence of cardio-respiratory composite events, compared to a standard of care, in patients undergoing bariatric surgery. As our results show association rather than causation, future prospective randomized trials are needed to confirm the benefit of enhanced monitoring. Findings of our study add to the existing literature involved in clinical management pathways to reduce the incidence of adverse postoperative outcomes in high-risk patients undergoing inpatient surgeries.
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Affiliation(s)
- Chenchen Tian
- Department of Anesthesiology, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Laura Hawryluck
- University of Toronto, Toronto, Ontario, Canada; Department of Intensive Care Medicine, Toronto Western Hospital, University Health Network, Canada
| | - George Tomlinson
- University of Toronto, Toronto, Ontario, Canada; Biostatistics Research Unit, Department of Medicine, University Health Network/Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - Frances Chung
- Department of Anesthesiology, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Scott Beattie
- Department of Anesthesiology, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Matthew Miller
- Department of Anaesthesia, St George Hospital, Sydney, Australia; University of New South Wales Australia, St George and Sutherland Clinical Schools, Australia
| | - Najia Hassan
- Department of Anesthesiology, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - David T Wong
- Department of Anesthesiology, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Jean Wong
- Department of Anesthesiology, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Julie Hudson
- Biostatistics Research Unit, Department of Medicine, University Health Network/Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - Timothy Jackson
- University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Toronto Western Hospital, University Health Network, Canada
| | - Mandeep Singh
- Department of Anesthesiology, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Department of Anesthesiology, Women's College Hospital, Toronto, Ontario, Canada.
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11
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Endo Y, Hirokawa T, Miyasho T, Takegawa R, Shinozaki K, Rolston DM, Becker LB, Hayashida K. Monitoring the tissue perfusion during hemorrhagic shock and resuscitation: tissue-to-arterial carbon dioxide partial pressure gradient in a pig model. J Transl Med 2021; 19:390. [PMID: 34774068 PMCID: PMC8590759 DOI: 10.1186/s12967-021-03060-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/27/2021] [Indexed: 11/20/2022] Open
Abstract
Background Despite much evidence supporting the monitoring of the divergence of transcutaneous partial pressure of carbon dioxide (tcPCO2) from arterial partial pressure carbon dioxide (artPCO2) as an indicator of the shock status, data are limited on the relationships of the gradient between tcPCO2 and artPCO2 (tc-artPCO2) with the systemic oxygen metabolism and hemodynamic parameters. Our study aimed to test the hypothesis that tc-artPCO2 can detect inadequate tissue perfusion during hemorrhagic shock and resuscitation. Methods This prospective animal study was performed using female pigs at a university-based experimental laboratory. Progressive massive hemorrhagic shock was induced in mechanically ventilated pigs by stepwise blood withdrawal. All animals were then resuscitated by transfusing the stored blood in stages. A transcutaneous monitor was attached to their ears to measure tcPCO2. A pulmonary artery catheter (PAC) and pulse index continuous cardiac output (PiCCO) were used to monitor cardiac output (CO) and several hemodynamic parameters. The relationships of tc-artPCO2 with the study parameters and systemic oxygen delivery (DO2) were analyzed. Results Hemorrhage and blood transfusion precisely impacted hemodynamic and laboratory data as expected. The tc-artPCO2 level markedly increased as CO decreased. There were significant correlations of tc-artPCO2 with DO2 and COs (DO2: r = − 0.83, CO by PAC: r = − 0.79; CO by PiCCO: r = − 0.74; all P < 0.0001). The critical level of oxygen delivery (DO2crit) was 11.72 mL/kg/min according to transcutaneous partial pressure of oxygen (threshold of 30 mmHg). Receiver operating characteristic curve analyses revealed that the value of tc-artPCO2 for discrimination of DO2crit was highest with an area under the curve (AUC) of 0.94, followed by shock index (AUC = 0.78; P < 0.04 vs tc-artPCO2), and lactate (AUC = 0.65; P < 0.001 vs tc-artPCO2). Conclusions Our observations suggest the less-invasive tc-artPCO2 monitoring can sensitively detect inadequate systemic oxygen supply during hemorrhagic shock. Further evaluations are required in different forms of shock in other large animal models and in humans to assess its usefulness, safety, and ability to predict outcomes in critical illnesses.
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Affiliation(s)
- Yusuke Endo
- The Feinstein Institutes for Medical Research, Northwell Health System, 350 Community Drive, Manhasset, NY, 11030, USA.,School of Veterinary Medicine, Rakuno Gakuen University, Hokkaido, Japan.,Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, USA
| | - Taku Hirokawa
- School of Veterinary Medicine, Rakuno Gakuen University, Hokkaido, Japan
| | - Taku Miyasho
- School of Veterinary Medicine, Rakuno Gakuen University, Hokkaido, Japan
| | - Ryosuke Takegawa
- The Feinstein Institutes for Medical Research, Northwell Health System, 350 Community Drive, Manhasset, NY, 11030, USA.,Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, USA
| | - Koichiro Shinozaki
- The Feinstein Institutes for Medical Research, Northwell Health System, 350 Community Drive, Manhasset, NY, 11030, USA.,Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Daniel M Rolston
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Lance B Becker
- The Feinstein Institutes for Medical Research, Northwell Health System, 350 Community Drive, Manhasset, NY, 11030, USA.,Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Kei Hayashida
- The Feinstein Institutes for Medical Research, Northwell Health System, 350 Community Drive, Manhasset, NY, 11030, USA. .,Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, USA.
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12
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Sørensen KM, Leicht RV, Carlsson CJ, Elvekjaer M, Porsbjerg C, Aasvang EK, Meyhoff CS. Agreement Between Transcutaneous Monitoring and Arterial Blood Gases During COPD Exacerbation. Respir Care 2021; 66:1560-1566. [PMID: 34074743 PMCID: PMC9993557 DOI: 10.4187/respcare.08510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Transcutaneous measurements of CO2 and O2 ([Formula: see text], [Formula: see text]) are noninvasive and allow for continuous monitoring in adults with exacerbation of COPD, but substantial accuracy issues may exist. We investigated agreement between results of arterial blood gas analysis and transcutaneous measurements of CO2 and O2 in patients with COPD. METHODS Adult subjects were monitored after acute admission to a respiratory intermediate care unit or ICU due to exacerbation of COPD and with ongoing noninvasive ventilation or immediately following extubation. Monitored variables were continuous transcutaneous measurement and simultaneous routine arterial blood gas analysis. Agreement between measurements was assessed by calculating bias with 95% limits of agreement for single-point estimates of [Formula: see text] versus [Formula: see text] and versus [Formula: see text], and for changes in transcutaneous measurements between 2 time points ([Formula: see text] and [Formula: see text]). We considered limits of agreement within ± 7.5 mm Hg to be acceptable. RESULTS A total of 57 transcutaneous measurements were made in 20 subjects for comparison with concurrent arterial blood gas analysis at 36 time points. The bias (limits of agreement) for [Formula: see text] and [Formula: see text] was 2.5 mm Hg (-10.6 to 15.6 mm Hg) and 11.2 mm Hg (-28.2 to 50.6 mm Hg), respectively. The bias for [Formula: see text] and [Formula: see text] was 2.3 mm Hg (-3.8 to 8.3 mm Hg) and -5.3 mm Hg (-37.5 to 27 mm Hg), respectively. CONCLUSIONS [Formula: see text] and [Formula: see text] did not accurately reflect results from arterial blood gas analyses in this study of mostly hypercapnic subjects. Agreement between changes in CO2 during the monitoring period was acceptable, however, and transcutaneous monitoring may be used for continuous monitoring of [Formula: see text] in conjunction with arterial blood gas analysis for reference.
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Affiliation(s)
- Kasper M Sørensen
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rebecca V Leicht
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christian J Carlsson
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Elvekjaer
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Celeste Porsbjerg
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Respiratory Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Eske K Aasvang
- Department of Anesthesiology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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13
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Iitani K, Ramamurthy SS, Ge X, Rao G. Transdermal sensing: in-situ non-invasive techniques for monitoring of human biochemical status. Curr Opin Biotechnol 2021; 71:198-205. [PMID: 34455345 DOI: 10.1016/j.copbio.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 12/15/2022]
Abstract
Improving life expectancy necessitates prevention and early diagnosis of any disease state based on active self-monitoring of symptoms and longitudinal biochemical profiling. Non-invasive and continuous measurement of molecular biomarkers that reflect metabolism and health must however be established to realize this plan. Human samples non-invasively obtained via the skin are suitable in this context for in-situ biochemical monitoring. We present a brief classification of transdermal sampling in aqueous and gaseous phases and then introduce a new generation of transdermal monitoring devices for rapid and accurate assessment of important parameters. Finally, we have summarized the diversity of body-wide skin characteristics that have possible effects for transdermal sampling. Because of its passive nature, in-situ biochemical monitoring via transdermal sampling will potentially lead to a greater understanding of important biochemical markers and their temporal variation.
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Affiliation(s)
- Kenta Iitani
- Center for Advanced Sensor Technology (CAST), Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County (UMBC), 1000 Hilltop Circle, Baltimore, MD, 21250 USA; Department of Life Science and Medical Bioscience, Graduate School of Advanced Science and Engineering, Waseda University (TWIns), 2-2 Wakamatsu-cho, Shinjuku-ku, Tokyo 162-8480, Japan; Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo 102-0083, Japan
| | - Sai Sathish Ramamurthy
- Center for Advanced Sensor Technology (CAST), Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County (UMBC), 1000 Hilltop Circle, Baltimore, MD, 21250 USA; STAR Laboratory, Department of Chemistry, Sri Sathya Sai Institute of Higher Learning, Prasanthi Nilayam, Puttaparthi, Anantapur, Andhra Pradesh 515134, India
| | - Xudong Ge
- Center for Advanced Sensor Technology (CAST), Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County (UMBC), 1000 Hilltop Circle, Baltimore, MD, 21250 USA
| | - Govind Rao
- Center for Advanced Sensor Technology (CAST), Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County (UMBC), 1000 Hilltop Circle, Baltimore, MD, 21250 USA.
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14
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Kikuta S, Ishihara S, Matsuyama S, Nakayama S. Prehospital management of a non-intubated inhalation injury patient using transcutaneous monitoring of carbon dioxide. BMJ Case Rep 2021; 14:14/7/e243869. [PMID: 34315747 PMCID: PMC8317070 DOI: 10.1136/bcr-2021-243869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 46-year-old man experienced facial burns due to a fire in his house. In the prehospital setting, suspecting inhalation injury and carbon monoxide poisoning, an emergency physician decided to bring him to the hospital for carbon dioxide (CO2) monitoring without endotracheal intubation for approximately 20 min because of less severe respiratory distress. On the way to the hospital, the patient's end-tidal CO2 monitoring ranged from 19 to 30 mm Hg, and transcutaneous carbon dioxide (TcPCO2) remained between 50 and 55 mm Hg. On arrival at the hospital, PaCO2 showed 51.6 mm Hg. Endotracheal intubation using a bronchoscope was performed in the emergency room, and inhalation injury was observed. He was extubated on day 5 and discharged on day 10. In the prehospital setting, TcPCO2 monitoring is useful for initial management of non-intubated inhalation injury patients even with high concentration oxygen.
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Affiliation(s)
- Shota Kikuta
- Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Hyogo, Japan
| | - Satoshi Ishihara
- Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Hyogo, Japan
| | - Shigenari Matsuyama
- Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Hyogo, Japan
| | - Shinichi Nakayama
- Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Hyogo, Japan
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15
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Frérou A, Maamar A, Rafi S, Lhommet C, Phelouzat P, Pontis E, Reizine F, Lesouhaitier M, Camus C, Le Tulzo Y, Tadié JM, Gacouin A. Monitoring Transcutaneously Measured Partial Pressure of CO 2 During Intubation in Critically Ill Subjects. Respir Care 2021; 66:1004-1015. [PMID: 33824171 DOI: 10.4187/respcare.08009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The risk for severe hypoxemia during endotracheal intubation is a major concern in the ICU, but little attention has been paid to CO2 variability. The objective of this study was to assess transcutaneously measured partial pressure of CO2 ([Formula: see text]) throughout intubation in subjects in the ICU who received standard oxygen therapy, high-flow nasal cannula oxygen therapy, or noninvasive ventilation for preoxygenation. We hypothesized that the 3 methods differ in terms of ventilation and CO2 removal. METHODS In this single-center, prospective, observational study, we recorded [Formula: see text] from preoxygenation to 3 h after the initiation of mechanical ventilation among subjects requiring endotracheal intubation. Subjects were sorted into 3 groups according to the preoxygenation method. We then assessed the link between [Formula: see text] variability and the development of postintubation hypotension. RESULTS A total of 202 subjects were included in the study. The [Formula: see text] values recorded at endotracheal intubation, at the initiation of mechanical ventilation, and after 30 min and 1 h of mechanical ventilation were significantly higher than those recorded during preoxygenation (P < .05). [Formula: see text] variability differed significantly according to the preoxygenation method (P < .001, linear mixed model). A decrease in [Formula: see text] by > 5 mm Hg within 30 min after the start of mechanical ventilation was independently associated with postintubation hypotension (odds ratio = 2.14 [95% CI 1.03-4.44], P = .039) after adjustments for age, Simplified Acute Physiology Score II, COPD, cardiac comorbidity, the use of propofol for anesthetic induction, and minute ventilation at the start of mechanical ventilation. CONCLUSIONS [Formula: see text] variability during intubation is significant and differs with the method of preoxygenation. A decrease in [Formula: see text] after the beginning of mechanical ventilation was associated with postintubation hypotension. (ClinicalTrials.gov registration NCT0388430.).
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Affiliation(s)
- Aurélien Frérou
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Adel Maamar
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Sonia Rafi
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Claire Lhommet
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Pierre Phelouzat
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Emmanuel Pontis
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Florian Reizine
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Mathieu Lesouhaitier
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Christophe Camus
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Yves Le Tulzo
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Jean-Marc Tadié
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Arnaud Gacouin
- Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
- Faculté de Médecine, Université de Rennes 1, Rennes, France
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16
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Juffermans NP, van den Brom CE, Kleinveld DJB. Targeting Endothelial Dysfunction in Acute Critical Illness to Reduce Organ Failure. Anesth Analg 2020; 131:1708-1720. [PMID: 33186159 DOI: 10.1213/ane.0000000000005023] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
During hyperinflammatory conditions that can occur in acute critical illness, such as shock or hypoperfusion, inflammatory mediators activate the endothelium, fueling a proinflammatory host-response as well as procoagulant processes. These changes result in shedding of the glycocalyx, endothelial hyperpermeability, edema formation, and lead to disturbed microcirculatory perfusion and organ failure. Different fluid strategies that are used in shock may have differential effects on endothelial integrity. Collectively, low protein content fluids seem to have negative effects on the endothelial glycocalyx, aggravating endothelial hyperpermeability, whereas fluids containing albumin or plasma proteins may be superior to normal saline in protecting the glycocalyx and endothelial barrier function. Targeting the endothelium may be a therapeutic strategy to limit organ failure, which hitherto has not received much attention. Treatment targets aimed at restoring the endothelium should focus on maintaining glycocalyx function and/or targeting coagulation pathways or specific endothelial receptors. Potential treatments could be supplementing glycocalyx constituents or inhibiting glycocalyx breakdown. In this review, we summarize mechanisms of endothelial dysfunction during acute critical illness, such as the systemic inflammatory response, shedding of the glycocalyx, endothelial activation, and activation of coagulation. In addition, this review focuses on the effects of different fluid strategies on endothelial permeability. Also, potential mechanisms for treatment options to reduce endothelial hyperpermeability with ensuing organ failure are evaluated. Future research is needed to elucidate these pathways and to translate these data to the first human safety and feasibility trials.
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Affiliation(s)
- Nicole P Juffermans
- From the Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Charissa E van den Brom
- Department of Anesthesiology, Amsterdam UMC, VU Amsterdam, Amsterdam, the Netherlands.,Experimental Laboratory for Vital Signs, Amsterdam UMC, VU Amsterdam, Amsterdam, the Netherlands
| | - Derek J B Kleinveld
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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17
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Perkhofer L, Strobel A, Gagiannis D, Seufferlein T, Schmidt K, Mayer B, Kleger A, Müller M. Transcutaneous carbon dioxide monitoring as a valid complementary method in acute respiratory failure. Eur Respir J 2020; 56:13993003.02137-2020. [DOI: 10.1183/13993003.02137-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/06/2020] [Indexed: 11/05/2022]
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18
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D'Souza B, Norman M, Sullivan CE, Waters KA. TcCO 2 changes correlate with partial obstruction in children suspected of sleep disordered breathing. Pediatr Pulmonol 2020; 55:2773-2781. [PMID: 32687262 DOI: 10.1002/ppul.24966] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Pediatric sleep disordered breathing (SDB) is characterized by long periods of partial upper airway obstruction (UAO) with low apnea-hypopnea indices (AHI). By measuring snoring and stertor, Sonomat studies allow quantification of these periods of partial UAO. AIM To determine whether transcutaneous CO2 (TcCO2 ) levels correlate with increasing levels of partial UAO and to examine patterns of ΔTcCo2 in the transitions from (a) wakefulness to sleep and (b) non-rapid eye movement (NREM) to rapid eye movement (REM) sleep. METHODS This was a retrospective review of sleep studies in seven asymptomatic controls aged 7 to 12 years and 62 symptomatic children with suspected SDB and no comorbidities, aged 2 to 13 years. Both groups underwent overnight polysomnography, including continuous TcCO2 , at one of two pediatric hospitals in Sydney. Changes in carbon dioxide levels between wake to NREM (sleep onset) and NREM to REM sleep were evaluated using an all-night TcCO2 trace time-linked to a hypnogram. Paired Sonomat recordings were used to quantify periods of UAO in the symptomatic group. RESULTS The ΔTcCO2 at sleep onset was greater in SDB children than controls and ΔTcCO2 with sleep onset correlated with the duration of partial obstruction (r = .60; P < .0001). Children with an increase in TcCO2 from NREM to REM had a higher number of snoring and stertor events compared to those in whom TcCO2 decreased from NREM to REM (91 vs 30 events/h; P = < .0001). CONCLUSIONS In children without comorbidities, the measurement of TcCO2 during sleep correlates with indicators of partial obstruction.
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Affiliation(s)
- Bebe D'Souza
- Professor Discipline of Child and Adolescent Health, The Children's Hospital at Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Norman
- Professor Discipline of Child and Adolescent Health, The Children's Hospital at Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - Colin E Sullivan
- Professor Discipline of Child and Adolescent Health, The Children's Hospital at Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - Karen A Waters
- Professor Discipline of Child and Adolescent Health, The Children's Hospital at Westmead, The University of Sydney, Sydney, New South Wales, Australia
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19
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Zhang Q, Murray GP, Hill JE, Harvey SL, Rojas-Pena A, Choi J, Zhou Y, Bartlett RH, Meyerhoff ME. Enhanced Hemocompatibility and In Vivo Analytical Accuracy of Intravascular Potentiometric Carbon Dioxide Sensors via Nitric Oxide Release. Anal Chem 2020; 92:13641-13646. [PMID: 32955253 DOI: 10.1021/acs.analchem.0c02979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In this letter, the innate ability of nitric oxide (NO) to inhibit platelet activation/adhesion/thrombus formation is employed to improve the hemocompatibility and in vivo accuracy of an intravascular (IV) potentiometric PCO2 (partial pressure of carbon dioxide) sensor. The catheter-type sensor is fabricated by impregnating a segment of dual lumen silicone tubing with a proton ionophore, plasticizer, and lipophilic cation-exchanger. Subsequent filling of bicarbonate and strong buffer solutions and placement of Ag/AgCl reference electrode wires within each lumen, respectively, enables measurement of the membrane potential difference across the inner wall of the tube, with this potential changing as a function of the logarithm of sample PCO2. The dual lumen device is further encapsulated within a S-nitroso-N-acetyl-DL-penicillamine (SNAP)-doped silicone tube that releases physiological levels of NO. The NO releasing sensor exhibits near-Nernstian sensitivity toward PCO2 (slope = 59.31 ± 0.78 mV/decade) and low drift rates (<2 mV/24 h after initial equilibration). In vivo evaluation of the NO releasing sensors, performed in the arteries and veins of anesthetized pigs for 20 h, shows enhanced accuracy (vs non-NO releasing sensors) when benchmarked to measurements of discrete blood samples made with a commercial blood gas analyzer. The accurate, continuous monitoring of blood PCO2 levels achieved with this new IV NO releasing PCO2 sensor configuration could help better manage hospitalized patients in critical care units.
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Affiliation(s)
- Qi Zhang
- Department of Chemistry, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Griffin P Murray
- Department of Chemistry, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Joseph E Hill
- Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Stephen L Harvey
- Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Alvaro Rojas-Pena
- Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States.,Department of Surgery, Section of Transplantation. University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Jonathan Choi
- Department of Chemistry, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Yang Zhou
- Key Laboratory of Advanced Materials of Tropical Island Resources of Ministry of Education and School of Chemical Engineering and Technology, Hainan University, Haikou, Hainan 570228, China
| | - Robert H Bartlett
- Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Mark E Meyerhoff
- Department of Chemistry, University of Michigan, Ann Arbor, Michigan 48109, United States
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