Monitoring Transcutaneously Measured Partial Pressure of CO(2) During Intubation in Critically Ill Subjects
| Autor: | Claire Lhommet, Arnaud Gacouin, Florian Reizine, Mathieu Lesouhaitier, Aurélien Frérou, Yves Le Tulzo, Jean-Marc Tadié, Pierre Phelouzat, Christophe Camus, Sonia Rafi, Adel Maamar, Emmanuel Pontis |
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| Přispěvatelé: | CHU Pontchaillou [Rennes], Université de Rennes - Faculté de Médecine (UR Médecine), Université de Rennes (UR), Université de Rennes 1 - Faculté de Médecine (UR1 Médecine), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES) |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
hypotension medicine.medical_treatment [SDV]Life Sciences [q-bio] mechanical ventilation Critical Care and Intensive Care Medicine medicine.disease_cause intensive care unit intubation law.invention 03 medical and health sciences 0302 clinical medicine law Oxygen therapy medicine Intubation Mechanical ventilation business.industry General Medicine Intensive care unit 3. Good health preoxygenation 030228 respiratory system Anesthesia Breathing Propofol business transcutaneous blood gas monitoring Nasal cannula Respiratory minute volume medicine.drug |
| Zdroj: | Respiratory Care Respiratory Care, 2021, ⟨10.4187/respcare.08009⟩ Respiratory Care, Daedalus Enterprises Inc, 2021, ⟨10.4187/respcare.08009⟩ |
| ISSN: | 0020-1324 1943-3654 |
| DOI: | 10.4187/respcare.08009⟩ |
| Popis: | BACKGROUND: The risk for severe hypoxemia during endotracheal intubation is a major concern in the ICU, but little attention has been paid to CO2 variability. The objective of this study was to assess transcutaneously measured partial pressure of CO2 ( P tcCO 2 ) throughout intubation in subjects in the ICU who received standard oxygen therapy, high-flow nasal cannula oxygen therapy, or noninvasive ventilation for preoxygenation. We hypothesized that the 3 methods differ in terms of ventilation and CO2 removal. METHODS: In this single-center, prospective, observational study, we recorded P tcCO 2 from preoxygenation to 3 h after the initiation of mechanical ventilation among subjects requiring endotracheal intubation. Subjects were sorted into 3 groups according to the preoxygenation method. We then assessed the link between P tcCO 2 variability and the development of postintubation hypotension. RESULTS: A total of 202 subjects were included in the study. The P tcCO 2 values recorded at endotracheal intubation, at the initiation of mechanical ventilation, and after 30 min and 1 h of mechanical ventilation were significantly higher than those recorded during preoxygenation (P P tcCO 2 variability differed significantly according to the preoxygenation method (P P tcCO 2 by > 5 mm Hg within 30 min after the start of mechanical ventilation was independently associated with postintubation hypotension (odds ratio = 2.14 [95% CI 1.03–4.44], P = .039) after adjustments for age, Simplified Acute Physiology Score II, COPD, cardiac comorbidity, the use of propofol for anesthetic induction, and minute ventilation at the start of mechanical ventilation. CONCLUSIONS: P tcCO 2 variability during intubation is significant and differs with the method of preoxygenation. A decrease in P tcCO 2 after the beginning of mechanical ventilation was associated with postintubation hypotension. (ClinicalTrials.gov registration NCT0388430.) |
| Databáze: | OpenAIRE |
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