End-Tidal Carbon Dioxide Pressure Measurement after Prolonged Inspiratory Time Gives a Good Estimation of the Arterial Carbon Dioxide Pressure in Mechanically Ventilated Patients
Open Access
- 27 November 2021
- journal article
- research article
- Published by MDPI AG in Diagnostics
- Vol. 11 (12), 2219
- https://doi.org/10.3390/diagnostics11122219
Abstract
Background: End-tidal carbon dioxide pressure (PetCO2) is unreliable for monitoring PaCO2 in several conditions because of the unpredictable value of the PaCO2–PetCO2 gradient. We hypothesised that increasing both the end-inspiratory pause and the expiratory time would reduce this gradient in patients ventilated for COVID-19 with Acute Respiratory Distress Syndrome and in patients anaesthetised for surgery. Methods: On the occasion of an arterial blood gas sample, an extension in inspiratory pause was carried out either by recruitment manoeuvre or by extending the end-inspiratory pause to 10 s. The end-expired PCO2 was measured (expiratory time: 4 s) after this manoeuvre (PACO2) in comparison with the PetCO2 measured by the monitor. We analysed 67 Δ(a-et)CO2, Δ(a-A)CO2 pairs for 7 patients in the COVID group and for 27 patients in the anaesthesia group. Results are expressed as mean ± standard deviation. Results: Prolongation of the inspiratory pause significantly reduced PaCO2–PetCO2 gradients from 11 ± 5.7 and 5.7 ± 3.4 mm Hg (p < 0.001) to PaCO2–PACO2 gradients of −1.2 ± 3.3 (p = 0.043) and −1.9 ± 3.3 mm Hg (p < 0.003) in the COVID and anaesthesia groups, respectively. In the COVID group, PACO2 showed the lowest dispersion (−7 to +6 mm Hg) and better correlation with PaCO2 (R2 = 0.92). The PACO2 had a sensitivity of 0.81 and a specificity of 0.93 for identifying hypercapnic patients (PaCO2 > 50 mm Hg). Conclusions: Measuring end-tidal PCO2 after prolonged inspiratory time reduced the PaCO2–PetCO2 gradient to the point of obtaining values close to PaCO2. This measure identified hypercapnic patients in both intensive care and during anaesthesia.This publication has 29 references indexed in Scilit:
- End-tidal arterial CO2 partial pressure gradient in patients with severe hypercapnia undergoing noninvasive ventilationOpen Access Emergency Medicine, 2013
- End-inspiratory rebreathing reduces the end-tidal to arterial PCO2 gradient in mechanically ventilated pigsIntensive Care Medicine, 2011
- Accuracy of Postoperative End-tidal Pco2Measurements with Mainstream and Sidestream Capnography in Non-obese Patients and in Obese Patients with and without Obstructive Sleep ApneaAnesthesiology, 2009
- Development of atelectasis and arterial to end-tidal Pco2-difference in a porcine model of pneumoperitoneumBritish Journal of Anaesthesia, 2009
- Accuracy and Precision of Three Different Methods to Determine Pco2 (Paco2 vs. Petco2 vs. Ptcco2) During Interhospital Ground Transport of Critically Ill and Ventilated AdultsThe Journal of Trauma and Acute Care Surgery, 2008
- Correlation of arterial Pco2 and Petco2 in prehospital controlled ventilationThe American Journal of Emergency Medicine, 2005
- Can prolonged expiration manoeuvres improve the prediction of arterial PCO2 from end-tidal PCO2?British Journal of Anaesthesia, 1997
- Negative arterial to end-tidal CO2 gradients in childrenCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 1994
- End-tidal carbon dioxide measurement in infants and children during and after general anaesthesiaCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 1994
- Accuracy of Capnography in Nonintubated Surgical PatientsSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 1992