Transcutaneous Pco2 to Monitor Noninvasive Mechanical Ventilation in Adults: Assessment of a New Transcutaneous Pco2 Device

doi:10.1378/chest.113.3.768

Chest

Volume 113, Issue 3, March 1998, Pages 768-773

https://doi.org/10.1378/chest.113.3.768 Get rights and content

The present study was designed to analyze the usability of a commercially available, transcutaneous Pco₂ (TcPco₂) sensor for monitoring noninvasive positive pressure ventilation (NPPV). Twenty-six hemodynamically stable patients with intra-arterial radial catheters were assessed. After stabilization of TcPco₂, arterial blood was analyzed and results were compared with TcPco₂ at time of sampling. To evaluate the drift of the signal, samples were taken hourly in five patients for 4 h while continuously recording TcPco₂. Finally, to assess for the response of the sensor to changes in PaCO₂, six patients underwent continuous TcPco₂ recording while initiating or interrupting NPPV; arterial samples were analyzed before the event, and 1, 3, 5, 7, 9, and 20 min afterwards.

Results

TcPco₂ and PaCO₂ were tested over a range of 26 to 71 mm Hg, and were found to be closely correlated (r=0.968, p<0.0001); mean bias was 0.75 mm Hg. There was no significant drift of TcPco₂ as compared with PaCO₂ over 4 h. The time of response of TcPco₂ to initiation or interruption of NPPV was <60 s. An estimation of the lag time averaged 5±3 min (range, 1 to 9 min).

Conclusion

TcPco₂ in hemodynamically stable adults was in excellent agreement with arterial measurements. The time of response to a change in ventilation was compatible with the aim of clinical monitoring of patients under NPPV.

Section snippets

Materials and Methods

The study protocol was approved by the Ethics Committee of the University Hospital of Geneva. Patients who had been admitted in the ICU and equipped with an indwelling arterial catheter were considered for the present study. To be included, they had to be in hemodynamically stable condition without vasopressor amine treatment other than low-dose dopamine (≤0.2 mg/min) to avoid cutaneous hypoperfusion or vasoconstriction. Twenty-six patients were included (18 men, 8 women, aged 68±10 years).

Results

Agreement between transcutaneous and arterial values for CO₂ was tested over a range of 26 to 71 mm Hg. TcPco₂ as a function of PaCO₂ is shown on Figure 2. Both measurements were highly correlated (r=0.968, p<0.001), and linear regression was close to the identity line (TcPco₂=1.116×PaCO₂—0.46). Figure 2 indicates that at high Pco₂ values, there was a trend for TcPco₂ to slightly overestimate PaCO₂. Figure 3 shows the d and limits of agreement between the TcPco₂ and PaCO₂. The d was 0.75 mm Hg;

Discussion

We have shown that TcPco₂ values, measured with the capnograph (Fastrac), showed a good agreement with simultaneous arterial measurements of PaCO₂, without significant drift after 4 h of continuous recording.

A review of published studies, as summarized in Table 1, shows conflicting results regarding agreement between TcPco₂ and PaCO₂.³,7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 Five studies, however, gave excellent correlation, two of them7, 11 indicating Pearson's coefficient of correlation (r)

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PaCO₂ values ranged from 3·97 kPa to 9.0 kPa. Thirty-six (53%) patients were hypercapnic. Correlation between PaCO₂ and PtcCO₂ was highly significant (r² = 0.9, p < 0.0001), Bias (d) and SD of bias (s) were 0.23 kPa and 0.28 kPa respectively, with a minor underestimation of PaCO₂. Limits of agreement (d ± 2s) were; −0.32; 0.79 kPa. None of the paired values of PaCO₂/PtcCO₂ had a difference exceeding 1 kPa. The mean drift of PtcCO₂ was 0.14 ± 0.54 kPa/8 h (p = 0.04; 95% CI: 0.01–0.27).
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Chest

Clinical Investigations in Critical CareTranscutaneous Pco2 to Monitor Noninvasive Mechanical Ventilation in Adults: Assessment of a New Transcutaneous Pco2 Device

Results

Conclusion

Section snippets

Materials and Methods

Results

Discussion

Chest

Crit Care Clin

Br J Anaesth

Chest

Chest

Chest

Chest

Noninvasive assessment of blood gases

Am Rev Respir Dis

Arterial line placement and care

Electrodes for blood Po2 and Pco2 determination

J Appl Physiol

TcPco2 electrode design, calibration and temperature gradient problems

Acta Anaesthesiol Scand

An ambulatory system for long-term continuous monitoring of transcutaneous Pco2

Bull Eur Physiopathol Respir

Evaluation of a single transcutaneous Po2-Pco2 sensor in adult patients

Crit Care Med

Clinical Investigations in Critical Care
Transcutaneous Pco₂ to Monitor Noninvasive Mechanical Ventilation in Adults: Assessment of a New Transcutaneous Pco₂ Device

Electrodes for blood Po₂ and Pco₂ determination

TcPco₂ electrode design, calibration and temperature gradient problems

An ambulatory system for long-term continuous monitoring of transcutaneous Pco₂

Evaluation of a single transcutaneous Po₂-Pco₂ sensor in adult patients