Transcutaneous versus blood carbon dioxide monitoring during acute noninvasive ventilation in the emergency department – a retrospective analysis
QUESTIONS UNDER STUDY: Transcutaneous measurement of carbon dioxide (PtCO2) has been suggested as an alternative to invasively obtained PaCO2 for the monitoring of patients with hypercapnic respiratory failure during noninvasive ventilation (NIV). Current data on monitoring in hypoxaemic respirato...
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| Format: | Article |
| Language: | English |
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SMW supporting association (Trägerverein Swiss Medical Weekly SMW)
2016-10-01
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| Series: | Swiss Medical Weekly |
| Subjects: | |
| Online Access: | https://www.smw.ch/index.php/smw/article/view/2239 |
| _version_ | 1811194168262787072 |
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| author | Christian Michael Horvath Martin Hugo Brutsche Florent Baty Jochen Julius Rüdiger |
| author_facet | Christian Michael Horvath Martin Hugo Brutsche Florent Baty Jochen Julius Rüdiger |
| author_sort | Christian Michael Horvath |
| collection | DOAJ |
| description |
QUESTIONS UNDER STUDY: Transcutaneous measurement of carbon dioxide (PtCO2) has been suggested as an alternative to invasively obtained PaCO2 for the monitoring of patients with hypercapnic respiratory failure during noninvasive ventilation (NIV). Current data on monitoring in hypoxaemic respiratory failure are scarce and show conflicting results in hypercapnic patients in the emergency department.
METHODS AND SETTING: We performed a retrospective comparison of real-time PtCO2 (SenTec Digital Monitor) and arterial/venous carbon dioxide tension (PaCO2/PvCO2) measurements in patients with severe hypoxaemic and/or hypercapnic respiratory failure during NIV. Agreement between PtCO2 and PaCO2/PvCO2 was the primary endpoint. Bland-Altman analysis and linear regression were used.
RESULTS: 102 patients had at least one matched measurement of PtCO2 and PaCO2/PvCO2. For patients with arterial blood gas analysis, the mean difference was 0.46 kPa at baseline (95% confidence interval [CI] 0.23 to 0.60, limits of agreement 95% CI –0.54 to 1.45) and 0.12 kPa after NIV (95% CI –0.04 to 0.29, limits of agreement 95% CI: –0.61 to 0.86). The linear regression analysis found a correlation R
2 of 0.88 (p <0.001) at baseline and an R
2 of 0.99 (p <0.001) after initiating NIV. For patients with venous blood gas analysis, the mean difference was 0.64 kPa at baseline (95% CI 0.04 to 1.24, limits of agreement 95% CI –0.72 to 2) and 0.80 kPa after NIV (95% CI 0.51 to 1.10, limits of agreement 95% CI 0.29 to 1.32), R
2 0.78 (p <0.001) at baseline and R
2 0.91 (p <0.001) after initiating NIV.
A PaCO2/PvCO2 >8 kPa was associated with a lesser degree of agreement between the levels of PtCO2 and PaCO2/PvCO2 (p <0.001).
CONCLUSION: Transcutaneous PCO2 monitoring shows a good concordance with PaCO2 and is a reliable, feasible, patient-friendly and safe alternative to repeated blood gas analysis for patients with severe hypoxaemic and/or hypercapnic respiratory failure receiving emergency NIV in the emergency department. An initial blood gas analysis to evaluate the respiratory and metabolic state and to rule out a significant discrepancy compared with the transcutaneous measurement is recommended.
Trials registration number: EKSG13/118
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| first_indexed | 2024-04-12T00:21:27Z |
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| id | doaj.art-a13005ddd0b945d5aa27e4e914f80921 |
| institution | Directory Open Access Journal |
| issn | 1424-3997 |
| language | English |
| last_indexed | 2024-04-12T00:21:27Z |
| publishDate | 2016-10-01 |
| publisher | SMW supporting association (Trägerverein Swiss Medical Weekly SMW) |
| record_format | Article |
| series | Swiss Medical Weekly |
| spelling | doaj.art-a13005ddd0b945d5aa27e4e914f809212022-12-22T03:55:42ZengSMW supporting association (Trägerverein Swiss Medical Weekly SMW)Swiss Medical Weekly1424-39972016-10-01146434410.4414/smw.2016.14373Transcutaneous versus blood carbon dioxide monitoring during acute noninvasive ventilation in the emergency department – a retrospective analysisChristian Michael HorvathMartin Hugo BrutscheFlorent BatyJochen Julius Rüdiger QUESTIONS UNDER STUDY: Transcutaneous measurement of carbon dioxide (PtCO2) has been suggested as an alternative to invasively obtained PaCO2 for the monitoring of patients with hypercapnic respiratory failure during noninvasive ventilation (NIV). Current data on monitoring in hypoxaemic respiratory failure are scarce and show conflicting results in hypercapnic patients in the emergency department. METHODS AND SETTING: We performed a retrospective comparison of real-time PtCO2 (SenTec Digital Monitor) and arterial/venous carbon dioxide tension (PaCO2/PvCO2) measurements in patients with severe hypoxaemic and/or hypercapnic respiratory failure during NIV. Agreement between PtCO2 and PaCO2/PvCO2 was the primary endpoint. Bland-Altman analysis and linear regression were used. RESULTS: 102 patients had at least one matched measurement of PtCO2 and PaCO2/PvCO2. For patients with arterial blood gas analysis, the mean difference was 0.46 kPa at baseline (95% confidence interval [CI] 0.23 to 0.60, limits of agreement 95% CI –0.54 to 1.45) and 0.12 kPa after NIV (95% CI –0.04 to 0.29, limits of agreement 95% CI: –0.61 to 0.86). The linear regression analysis found a correlation R 2 of 0.88 (p <0.001) at baseline and an R 2 of 0.99 (p <0.001) after initiating NIV. For patients with venous blood gas analysis, the mean difference was 0.64 kPa at baseline (95% CI 0.04 to 1.24, limits of agreement 95% CI –0.72 to 2) and 0.80 kPa after NIV (95% CI 0.51 to 1.10, limits of agreement 95% CI 0.29 to 1.32), R 2 0.78 (p <0.001) at baseline and R 2 0.91 (p <0.001) after initiating NIV. A PaCO2/PvCO2 >8 kPa was associated with a lesser degree of agreement between the levels of PtCO2 and PaCO2/PvCO2 (p <0.001). CONCLUSION: Transcutaneous PCO2 monitoring shows a good concordance with PaCO2 and is a reliable, feasible, patient-friendly and safe alternative to repeated blood gas analysis for patients with severe hypoxaemic and/or hypercapnic respiratory failure receiving emergency NIV in the emergency department. An initial blood gas analysis to evaluate the respiratory and metabolic state and to rule out a significant discrepancy compared with the transcutaneous measurement is recommended. Trials registration number: EKSG13/118 https://www.smw.ch/index.php/smw/article/view/2239emergencyNIVrespiratory failuretranscutaneous CO2 measurement |
| spellingShingle | Christian Michael Horvath Martin Hugo Brutsche Florent Baty Jochen Julius Rüdiger Transcutaneous versus blood carbon dioxide monitoring during acute noninvasive ventilation in the emergency department – a retrospective analysis Swiss Medical Weekly emergency NIV respiratory failure transcutaneous CO2 measurement |
| title | Transcutaneous versus blood carbon dioxide monitoring during acute noninvasive ventilation in the emergency department – a retrospective analysis |
| title_full | Transcutaneous versus blood carbon dioxide monitoring during acute noninvasive ventilation in the emergency department – a retrospective analysis |
| title_fullStr | Transcutaneous versus blood carbon dioxide monitoring during acute noninvasive ventilation in the emergency department – a retrospective analysis |
| title_full_unstemmed | Transcutaneous versus blood carbon dioxide monitoring during acute noninvasive ventilation in the emergency department – a retrospective analysis |
| title_short | Transcutaneous versus blood carbon dioxide monitoring during acute noninvasive ventilation in the emergency department – a retrospective analysis |
| title_sort | transcutaneous versus blood carbon dioxide monitoring during acute noninvasive ventilation in the emergency department a retrospective analysis |
| topic | emergency NIV respiratory failure transcutaneous CO2 measurement |
| url | https://www.smw.ch/index.php/smw/article/view/2239 |
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