Comparison of End-Tidal, Arterial, Venous, and Transcutaneous PCO2.

Published on Oct 1, 2019in Respiratory Care2.066
· DOI :10.4187/RESPCARE.06094
Shota Fujimoto1
Estimated H-index: 1
Manabu Suzuki5
Estimated H-index: 5
+ 7 AuthorsHaruhito Sugiyama19
Estimated H-index: 19
BACKGROUND: We investigated the measurement of end-tidal partial pressure of carbon dioxide (PETCO2) with a capnometer in patients with respiratory failure, and we determined whether this technique could provide an alternative to measurement of PaCO2 using arterial blood gas analysis in the clinical setting. METHODS: We measured PETCO2 in subjects with hypoxemic and hypercarbic respiratory failure using a capnometer. We simultaneously measured PaCO2, venous partial pressure of carbon dioxide (PvCO2), and transcutaneously measured partial pressure PCO2 (PtcCO2). We analyzed agreements among these parameters with Bland-Altman analysis. We obtained 30 samples from subjects with hypoxemic respiratory failure and 30 samples from subjects with hypercarbic respiratory failure. RESULTS: Thirty subjects with hypoxemic respiratory failure and 18 subjects with hypercarbic respiratory failure participated in this study. Significant relationships were found between PETCO2 and PaCO2, between PtcCO2 and PaCO2, and between PvCO2 and PaCO2. Bland-Altman analysis of PETCO2 and PaCO2 in all subjects revealed a bias of 6.48 mm Hg (95% CI 4.93–8.03, P CONCLUSIONS: PETCO2 can be measured simply using a capnometer, and PETCO2 measurements can estimate PaCO2. However, the limits of agreement were wide. Therefore, care providers must pay attention to the characteristics and errors of these devices. These results suggest that measurement of PETCO2 might be useful for screening for hypercarbic respiratory failure in the clinical setting.
Figures & Tables
📖 Papers frequently viewed together
4 Citations
1 Citations
#1Kyung Woo Kim (Inje University)H-Index: 7
#2Hey Ran Choi (Inje University)H-Index: 6
Last. Jeong-wook Lee (Inje University)H-Index: 1
view all 4 authors...
An end-tidal CO2 monitor (capnometer) is used most often as a noninvasive substitute for PaCO2 in anesthesia, anesthetic recovery, and intensive care. Additionally, the wide spread on-site use of portable capnometers in emergency and trauma situations is now observed. This study was conducted to compare PaCO2 measurement between the EMMA™ portable-capnometer and sidestream capnometry. End-tidal CO2 (portable capnometer: EMMA™ capnograph, side stream capnometry module: Datex-Ohmeda S5 Anesthesia ...
7 CitationsSource
#1Tricia M. McKeever (University of Nottingham)H-Index: 53
#2Glenn Hearson (University of Nottingham)H-Index: 5
Last. Dominick E. Shaw (University of Nottingham)H-Index: 27
view all 8 authors...
Introduction Identifying acute hypercapnic respiratory failure is crucial in the initial management of acute exacerbations of COPD. Guidelines recommend obtaining arterial blood samples but these are more difficult to obtain than venous. We assessed whether blood gas values derived from venous blood could replace arterial at initial assessment. Methods Patients requiring hospital treatment for an exacerbation of COPD had paired arterial and venous samples taken. Bland–Altman analyses were perfor...
27 CitationsSource
ISTORICALLY, anesthesiologists seem to be the forerunners in implementing tools and standards for safety in the medical fraternity. In the United States, since 1985, there has been a dramatic decrease in the malpractice insurance premiums of anesthesiologists. Such a decrease has not been seen in other medical or surgical specialties over this time frame. Thanks to the foresight of the American Society of Anesthesiologists (ASA), Anesthesia Patient Safety Foundation (APSF), Association of Anaest...
80 CitationsSource
#1Brian K Walsh (Children's Medical Center of Dallas)H-Index: 19
#2David N Crotwell (Boston Children's Hospital)H-Index: 2
Last. Ruben D Restrepo (University of Texas at Austin)H-Index: 19
view all 3 authors...
We searched the MEDLINE, CINAHL, and Cochrane Library databases for articles published between January 1990 and November 2010. The update of this clinical practice guideline is based on 234 clinical studies and systematic reviews, 19 review articles that investigated capnography/capnometry during mechanical ventilation, and the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The following recommendations are made following the Gradi...
67 CitationsSource
#1Ira M. Cheifetz (Duke University)H-Index: 43
#2Timothy R Myers (Case Western Reserve University)H-Index: 16
One of the most important aspects of caring for a critically ill patient is monitoring. Few would disagree that the most essential aspect of monitoring is frequent physical assessments. Complementing the physical examination is continuous monitoring of heart rate, respiratory rate, and blood oxygen saturation measured via pulse-oximetry, which have become the standard of care in intensive care units. Over the past decade one of the most controversial aspects of monitoring critically ill patients...
54 Citations
#2Stefano Di Bernardo (Boston Children's Hospital)H-Index: 4
Last. Markus WeissH-Index: 58
view all 6 authors...
Background: The recently introduced TOSCA monitor (Linde Medical Sensors AG, Basel, Switzerland) combines pulse oximetry (SpO 2 ) and transcutaneous PCO 2 (PtcCO 2 ) monitoring in a single ear sensor. The aim of the present study was to evaluate accuracy of the TOSCA monitor to estimate SaO 2 and PaCO 2 in anaesthetized children. Methods: With approval of the hospital ethical committee and after obtaining informed parental consent, the TOSCA sensor was attached to one ear lobe of anaesthetized c...
63 CitationsSource
#1M. SimonH-Index: 1
#2R. GottschallH-Index: 1
Last. U. KleinH-Index: 1
view all 6 authors...
Objective: To compare endtidal and transcutaneous respiratory monitoring of high-frequency jet ventilation (HFJV) in rigid bronchoscopy. Both techniques provide a noninvasive measurement of pCO2. Methods: High-frequency jet ventilation was applied via a rigid bronchoscope. Driving pressure (DP) was initially adapted to ensure normal ventilation. It was then changed twice by ±30% from the initial value. Endtidal and transcutaneous data were compared with arterial blood gas monitoring (ABG). Resul...
25 CitationsSource
#1Charles D McArthur (Mayo Clinic)H-Index: 1
#2AarcH-Index: 1
25 Citations
#1Patrick EberhardH-Index: 3
Last. D. R. SpahnH-Index: 1
view all 4 authors...
We are describing the preliminary results of tests performed in adult volunteers and in adult patients during and after general anesthesia with a miniaturized single sensor combining the continuous and non-invasive measurement of oxygen saturaiton by pulse oximetry (SpO 2 ) and transcutaneous PCO 2 (OxiCarbo® sensor). The sensor is heated to 42°C to arterialize the cutaneous tissue and is applied at the ear lobe with a special low-pressure clip. The results indicate a good agreement between ear ...
75 Citations
#1Cynthia T. Anderson (UCI: University of California, Irvine)H-Index: 6
#2Peter H. Breen (UCI: University of California, Irvine)H-Index: 15
Greater understanding of the pathophysiology of carbon dioxide kinetics during steady and nonsteady state should improve, we believe, clinical care during intensive care treatment. Capnography and the measurement of end-tidal partial pressure of carbon dioxide (PETCO2) will gradually be augmented by relatively new measurement methodology, including the volume of carbon dioxide exhaled per breath (VCO2,br) and average alveolar expired PCO2 (PǢCO2). Future directions include the study of oxygen ki...
127 CitationsSource
Cited By2
#2Lorenz Meuli (UZH: University of Zurich)
Last. Urs Pietsch (University of Bern)H-Index: 1
view all 8 authors...
Early definitive airway protection and normoventilation are key principles in the treatment of severe traumatic brain injury. These are currently guided by end tidal CO2 as a proxy for PaCO2. We assessed whether the difference between end tidal CO2 and PaCO2 at hospital admission is associated with in-hospital mortality. We conducted a retrospective observational cohort study of consecutive patients with traumatic brain injury who were intubated and transported by Helicopter Emergency Medical Se...
#2Fatih Selvi (Health Science University)H-Index: 1
Last. Ömer Faruk Karakoyun (Muğla University)
view all 4 authors...
Capnography is the non-invasive measurement and graphic representation of the partial pressure of CO2 in expiration. Although there are many studies in the literature comparing the partial pressure of carbon dioxide (pCO2) and end-tidal CO2 (ETCO2) values in patients who underwent IMV (invasive mechanical ventilation), there are no studies showing their interchangeable applicability in patients who received NIMV (non-IMV). We aimed to evaluate whether the use of ETCO2 in the treatment process ca...
Respiratory monitoring in patients receiving oxygen therapy for acute care is mandatory at the initial stage of in-hospital management given the potential risk of clinical worsening. Although some patients benefit from close monitoring in the ICU, the vast majority of them are managed in general wards with reduced staff and clinical supervision. The objective of monitoring is to detect early clinical deterioration, which may help prevent in-hospital cardiac arrest. In addition to the clinical an...
1 CitationsSource