Article

Evaluation of a transcutaneous carbon dioxide monitor in severe obesity

Section of Respiratory Medicine, Hospital S. Maria della Pietà, CAP 80026, Casoria, Naples, Italy.
Intensive Care Medicine (Impact Factor: 7.21). 08/2008; 34(7):1340-4. DOI: 10.1007/s00134-008-1078-8
Source: PubMed

ABSTRACT

To determine the reliability of estimating arterial CO(2) pressure (PaCO(2)) using a recently introduced transcutaneous CO(2) pressure (PtcCO(2)) monitor in severe obese patients.
Observational and interventional study.
District hospital with respiratory ward and bariatric surgery unit.
PtcCO(2) was measured in 35 obese patients with varied pathology, including chronic obstructive pulmonary disease, obstructive sleep apnea syndrome and hypoventilation syndrome. Ten minutes after the probe had been attached to an earlobe, PtcCO(2) was recorded immediately before arterial blood sampling. The PtcCO(2) and PaCO(2) values obtained with two methods were compared by Bland-Altman analysis. In a subgroup of 18 obese patients with chronic obstructive pulmonary disease and/or obstructive sleep apnea syndrome with moderate to severe hypercapnia both PtcCO(2) and PaCO(2) were re-evaluated during continuous positive airways pressure (CPAP) or bi-level positive airway pressure (Bi-PAP) treatment.
The mean difference between PaCO(2) and PtcCO(2) was -1.4 mmHg, and the standard deviation of the difference was 1.3 mmHg. Bland-Altman analysis showed generally good agreement between the two methods with a 95% limit of agreement of -4 to 1.1. The agreement between methods did not significantly change before and during cPAP or Bi-PAP treatment in hypercapnic patients.
The accuracy of estimation of PaCO(2) by transcutaneous monitoring was generally good in comparison with standard arterial blood gases examination. The device appears to be promising for use in obese patients to evaluate abnormalities in their alveolar ventilation.

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Available from: Pierluigi carratù, Sep 14, 2015
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    • "Griffin J et al [4] found that carbon dioxide monitoring by using PTCCO2 was more accurate in patients with a BMI greater than 40 kg/m2 undergoing transabdominal bariatric surgery. Maniscalco M et al [12] suggested that in patients (BMI, 43.7 kg/m2) with chronic obstructive pulmonary disease (COPD), obstructive sleep apnea syndrome (OSAS), hypopnea syndrome (OHS) and respiratory failure (RF), PTCCO2 still accurately reflected the PaCO2,compared with the blood gas analysis. Our findings indicated that PTCCO2 was more accurate in reflecting the real levels of PaCO2 than PetCO2 in patients with BMI>35 kg/m2 undergoing laparoscopic bariatric surgery. "
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    ABSTRACT: To investigate the correlation and accuracy of transcutaneous carbon dioxide partial pressure (PTCCO2) with regard to arterial carbon dioxide partial pressure (PaCO2) in severe obese patients undergoing laparoscopic bariatric surgery. Twenty-one patients with BMI>35 kg/m2 were enrolled in our study. Their PaCO2, end-tidal carbon dioxide partial pressure (PetCO2), as well as PTCCO2 values were measured at before pneumoperitoneum and 30 min, 60 min, 120 min after pneumoperitoneum respectively. Then the differences between each pair of values (PetCO2-PaCO2) and. (PTCCO2-PaCO2) were calculated. Bland-Altman method, correlation and regression analysis, as well as exact probability method and two way contingency table were employed for the data analysis. 21 adults (aged 19-54 yr, mean 29, SD 9 yr; weight 86-160 kg, mean119.3, SD 22.1 kg; BMI 35.3-51.1 kg/m2, mean 42.1,SD 5.4 kg/m2) were finally included in this study. One patient was eliminated due to the use of vaso-excitor material phenylephrine during anesthesia induction. Eighty-four sample sets were obtained. The average PaCO2-PTCCO2 difference was 0.9±1.3 mmHg (mean±SD). And the average PaCO2-PetCO2 difference was 10.3±2.3 mmHg (mean±SD). The linear regression equation of PaCO2-PetCO2 is PetCO2 = 11.58+0.57×PaCO2 (r2 = 0.64, P<0.01), whereas the one of PaCO2-PTCCO2 is PTCCO2 = 0.60+0.97×PaCO2 (r2 = 0.89). The LOA (limits of agreement) of 95% average PaCO2-PetCO2 difference is 10.3±4.6 mmHg (mean±1.96 SD), while the LOA of 95% average PaCO2-PTCCO2 difference is 0.9±2.6 mmHg (mean±1.96 SD). In conclusion, transcutaneous carbon dioxide monitoring provides a better estimate of PaCO2 than PetCO2 in severe obese patients undergoing laparoscopic bariatric surgery.
    Full-text · Article · Apr 2014 · PLoS ONE

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    ABSTRACT: La mesure de la pression transcutanée en dioxyde de carbone (PtcCO2) n’est pas une technologie récente, les premiers essais remontant au début des années 1960. L’amélioration des moniteurs, la miniaturisation et le développement des électrodes utilisées permettent aujourd’hui de proposer en routine une surveillance de la PtcCO2 continue, fiable, non invasive, simple et rapide. Cet accès indirect et simple à la pression artérielle en CO2 (PaCO2) est pour le clinicien une aide précieuse dans nombre de situations cliniques. Les moniteurs actuels permettent de mesurer aussi de façon rapide et non invasive bien d’autres paramètres (saturation transcutanée en oxygène, fréquences respiratoire et cardiaque, indice de perfusion tissulaire…), utiles pour apprécier la fonction respiratoire d’un patient et pour en suivre l’évolution dans le temps. La tendance actuelle en réanimation est de faire le monitorage le moins invasif possible, même s’il convient d’être prudent quant à l’utilisation abusive ou inadéquate des paramètres ainsi mesurés. Cette revue fait la synthèse du mode de fonctionnement, des avantages et limites, ainsi que des domaines d’application des outils de mesure de la PtcCO2.
    No preview · Article · Mar 2012 · Réanimation
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