Use of maximum end-tidal CO(2) values to improve end-tidal CO(2) monitoring accuracy
| Autor: | Fabrice Galia, Jean Louis Vincent, Laurent Brochard, Serge Brimioulle, Frédéric Bonnier, Michel Dojat, Nicolas Vandenbergen |
|---|---|
| Přispěvatelé: | Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Department of Intensive Care, Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB)-Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Neuro-imagerie fonctionnelle et métabolique (ANTE-INSERM U836, équipe 5), Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), INSERM U955, équipe 13, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Geneva University Hospital, Geneva University Hospital (HUG)-Geneva University Hospital (HUG)-Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Dojat, Michel |
| Jazyk: | angličtina |
| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_treatment Critical Care and Intensive Care Medicine MESH: Tidal Volume [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract Cohort Studies Hypercapnia 0302 clinical medicine MESH: Respiration Artificial MESH: Cohort Studies MESH: Aged COPD MESH: Middle Aged General Medicine Middle Aged End tidal 3. Good health MESH: Reproducibility of Results Anesthesia Breathing Arterial blood Female Respiratory Insufficiency Pulmonary and Respiratory Medicine MESH: Hypocapnia 03 medical and health sciences Capnography Intensive care Tidal Volume medicine Humans Oxygen pressure Aged Mechanical ventilation MESH: Humans Hypocapnia Pulmonary Gas Exchange business.industry Reproducibility of Results 030208 emergency & critical care medicine MESH: Capnography medicine.disease Respiration Artificial MESH: Male 030228 respiratory system MESH: Hypercapnia [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract business MESH: Pulmonary Gas Exchange Closed loop MESH: Female MESH: Respiratory Insufficiency |
| Zdroj: | Respiratory Care Respiratory Care, Daedalus Enterprises Inc, 2011, 56 (3), pp.278-83. ⟨10.4187/respcare.00837⟩ |
| ISSN: | 0020-1324 1943-3654 |
| DOI: | 10.4187/respcare.00837⟩ |
| Popis: | BACKGROUND: The arterial partial pressure of CO 2 (P aCO2 ) can be grossly estimated by the end-tidal partial pressure of CO 2 (PETCO2 ). This principle is used in SmartCare (Drager, Lubeck, Germany), which is an automated closed-loop system that uses PETCO2 to estimate alveolar venti- lation during mechanical ventilation. OBJECTIVE: To assess whether the maximum PETCO2 value (instead of the averaged PETCO2 value) over 2-min or 5-min periods improves PaCO2 estimation, and determine the consequences for the SmartCare system. METHODS: We continuously monitored breath-by-breath PETCO2 during ventilation with SmartCare in 36 patients mechanically ventilated for various disorders, including 14 patients with COPD. Data were collected simultaneously from SmartCare recordings, every 2 min or 5 min, and through a dedicated software that recorded ventilation data every 10 s. We compared the maximum and averaged PETCO2 values over 2-min and 5-min periods to the PaCO2 measured from 80 arterial blood samples clinically indicated in 26 pa- tients. We also compared SmartCare's classifications of patient ventilatory status based on aver- aged PETCO2 values to what the classifications would have been with the maximum PETCO2 values. RESULTS: Mean PaCO2 was 44 11 mm Hg. PaCO2 was higher than averaged PETCO2 by 10 6 mm Hg, and this difference was reduced to 6 6 mm Hg with maximum PETCO2 . The results were similar whether patients had COPD or not. Very few aberrant values (< 0.01%) needed to be discarded. Among the 3,137 classifications made by the SmartCare system, 1.6% were changed by using the maximum PETCO2 value instead of the averaged PETCO2 value. CONCLUSIONS: Use of maximum PETCO2 reduces the difference between PaCO2 and PETCO2 and improves SmartCare's classification of patient ventilatory status. Key words: alveolar ventilation; capnometry; monitoring; mechanical ventilation; closed loop systems; weaning. (Respir Care 2011;56(3):278 -283. © 2011 Daeda- lus Enterprises) |
| Databáze: | OpenAIRE |
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