Invasive CO 2 monitoring with arterial line compared to end tidal CO 2 during peroral endoscopic myotomy.

Autor: Duarte-Chavez R; Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States., Tyberg A; Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States., Sarkar A; Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States., Shahid HM; Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States., Vemulapalli B; Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States., Shah-Khan S; Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States., Gaidhane M; Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States., Kahaleh M; Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States.
Jazyk: angličtina
Zdroj: Endoscopy international open [Endosc Int Open] 2023 May 09; Vol. 11 (5), pp. E468-E473. Date of Electronic Publication: 2023 May 09 (Print Publication: 2023).
DOI: 10.1055/a-2048-1312
Abstrakt: Background and study aims  Peroral endoscopic myotomy (POEM) has become a recognized treatment for achalasia. The technique requires CO 2 insufflation. It is estimated that the partial pressure of CO 2 (PaCO 2 ) is 2 to 5 mm Hg higher than the end tidal CO 2 (etCO 2 ), and etCO 2 is used as a surrogate for PaCO 2 because PaCO 2 requires an arterial line. However, no study has compared invasive and noninvasive CO 2 monitoring during POEM. Patients and methods  Seventy-one patients who underwent POEM were included in a prospective comparative study. PaCO 2 plus etCO 2 was measured in 32 patients (invasive group) and etCO 2 only in 39 matched patients (noninvasive group). Pearson correlation coefficient (PCC) and Spearman's Rho were used to calculate the correlation between PaCO 2 and ETCO 2 . Results  PaCO 2 and ETCO 2 were strongly correlated: PCC R value: 0.8787 P  ≤ 0.00001, Spearman's Rho R value: 0.8775, P  ≤ 0.00001. Within the invasive group, the average difference between PaCO 2 and ETCO 2 was 3.39 mm Hg (median 3, standard deviation 3.5), within the 2- to 5-mm Hg range. The average procedure time (scope in to scope out) was increased 17.7 minutes ( P  = 0.044) and anesthesia duration was 46.3 minutes. Adverse events (AEs) included three hematomas and one nerve injury in the invasive group and one pneumothorax in the noninvasive group. There were no differences in AE rates between the groups (13 % vs 3 % P  = 0.24). Conclusions  Universal PaCO 2 monitoring contributes to increased procedure and anesthesia times without any decrease in AEs in patients undergoing POEM. CO 2 monitoring with an arterial line should only be performed in patients with major cardiovascular comorbidities; in all other patients, ETCO 2 is an appropriate tool.
Competing Interests: Competing interests Dr. Tyberg is a consultant for Ninepoint Medical, Endogastric Solutions, and Obalon Therapeutics. Dr. Sarkar has done consulting work for US Endoscopy and Obalon Therapeutics. Dr. Shahid has done consulting work for US Endoscopy. Dr. Kahaleh has received grant support from Boston Scientific, Fujinon, W.L. Gore, Apollo Endosurgery, Cook Endoscopy, GI Dynamics, Merit Medical, Interscope Med, Olympus, ERBE, and MI Tech. He is a consultant for Boston Scientific and Laboratories Inc., AbbVie. None of that funding was related to this paper. Dr. Gaidhane is a consultant for 3 D Matrix.
(The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)
Databáze: MEDLINE
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