P39 Noninvasive pH with Transcutaneous PCO2monitoring as an alternative to arterial line sampling: a new patient friendly approach to monitoring Acute NIV
| Autor: | M Sovani, I Adejumo, J Khan |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Pulmonary and Respiratory Medicine
Acute hypercapnic respiratory failure business.industry Bicarbonate Arterial Blood Gas Measurement medicine.disease Transcutaneous pco2 Henderson–Hasselbalch equation chemistry.chemical_compound Respiratory acidosis chemistry Anesthesia medicine Arterial blood Arterial line business |
| Zdroj: | Thorax. 70:A95.1-A95 |
| ISSN: | 1468-3296 0040-6376 |
| DOI: | 10.1136/thoraxjnl-2015-207770.176 |
| Popis: | Arterial blood gas measurement is a standard way to initiate and monitor Noninvasive ventilation (NIV) in acute hypercapnic respiratory Failure. It is painful for patients and time and resource intensive for staff. In a pilot study we have demonstrated that transcutaneous CO 2 monitoring provides reliable CO 2 measurements in patients with Acute Hypercapnic Respiratory Failure (AHRF). Moreover this is less painful and preferred by patients. van Oppen et al ., Respir Care. 2014 Nov 18. pii: respcare.03335. PCO 2 time trends were concordant. Mean PCO 2 bias was -2.33 mm Hg (95%LOA -9.60 to 5.03) mmHg, r = 0.89 (p Particularly in patients with AHRF due to COPD exacerbation pH plays an important role in initiating and guiding therapy. We explored whether TcCO 2 can be used to predict pH thereby minimising the need for repeated arterial blood gases in this patient group. Based on Henderson Hasselbalch equation pH = 6.1+ log (HCO3/CO2). In the pilot study mentioned above Non-invasive pHtc was determined using ptcCO2 and predicted bicarbonate. Reference bicarbonate’ was recorded from ABG taken at NIV initiation. TcCO2 was monitored continuously over 12 h using Radiometer TOSCA TCM4. PaCO 2 was obtained from arterial blood samples at 0, 4, 8 and 12 h. Mean pH bias was 0.012 (95%LOA -0.070 to 0.094), r = 0.84 (p We have subsequently reviewed records for 38 patients who received Acute NIV for AHRF. We retrospectively looked at change in pH, bicarbonate and CO 2 over 24, 48 and 72 h. Using these data and Henderson Hasselbach equation we can show that in the first 48 h change in pH is almost exclusively explained by change in CO 2 (Pearsons Correlation coefficient for change in CO 2 and pH = 0.84; p Therefore in patients with pure Respiratory Acidosis transcutaneous CO 2 would provide trend for pH as well as CO 2 , thereby minimising the need for arterial blood gas measurement and improve patient comfort. Reference 1 van Oppen JD, Daniel PS, Sovani MP. What is the potential role of transcutaneous carbon dioxide in guiding acute noninvasive ventilation? Respir Care . 2015; 60 :484–91 |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|