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Non-invasive ventilation (NIV) is the treatment of choice for persistent hypercapnic ventilatory failure during acute exacerbations of chronic obstructive pulmonary disease (AECOPD), despite optimal medical treatment.1,2 Assessment of the partial arterial pressure of carbon dioxide (Paco2) is the “gold standard” for the evaluation of the adequacy of alveolar ventilation in this setting. However, repeated intermittent invasive arterial puncture carries inherent risks, including pain.3 Transcutaneous measurement of carbon dioxide (TcPco2) theoretically appears more appropriate for monitoring Paco2. This measurement is based on the observation that CO2 has a high tissue solubility and diffuses through the skin. While available data as to the precision of TcPco2 measurements have given conflicting results,4–6 no study has attempted to assess simultaneous recordings of TcPco2 and Paco2 in patients requiring NIV for AECOPD.
We prospectively studied the agreement between TcPco2 …