Price Daniel D, Wilson Sharon R, Fee Mary E
Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA.
Air Med J. 2007 Jan-Feb;26(1):55-9. doi: 10.1016/j.amj.2006.10.004.
End-tidal carbon dioxide (EtCO(2)) monitoring is standard of care for intubated patients. Sidestream technology also allows EtCO(2) monitoring in non-intubated patients. This is the first study to evaluate the feasibility of monitoring sidestream EtCO(2) on intubated and non-intubated patients during helicopter transport.
An air medical transport program serving two level 1 trauma centers.
In this prospective observational study, sidestream EtCO2 was monitored in 100 consecutive patients transported by helicopter. Flight nurses rated the difficulty posed by various factors of sidestream monitoring. An experienced flight nurse and a clinical engineer evaluated waveforms and EtCO(2) values.
Only 1 of the 100 transported patients required a change from sidestream to mainstream EtCO(2) monitoring. Moisture was noted in the tubing of two patients, and one was changed to mainstream. Eleven patients had occluded nares but were not changed to mainstream monitoring. On a 5-point Likert scale, responses to statements regarding difficulty with length of tubing, patient tolerance, and interference with patient care produced mean scores of 0.5 (range, 0-3). Responses regarding difficulty securing the cannula yielded a mean score of 0.7 (range, 0-3). Of 1,685 (99%) recorded EtCO(2) values, 1,668 met pre-established criteria for "consistent." Alveolar plateaus were identified in 81 of 94 (86%) patient waveforms by the flight nurse and 73 of 94 (78%) patient waveforms by the clinical engineer.
Sidestream EtCO(2) monitoring is feasible during air medical transport of both intubated and non-intubated patients. The mechanism was easy to use, and consistent numeric values and waveforms with alveolar plateaus were obtained in a large majority of readings.
呼气末二氧化碳（EtCO₂）监测是气管插管患者的护理标准。旁流技术也可用于非气管插管患者的EtCO₂监测。这是第一项评估在直升机转运过程中对气管插管和非气管插管患者进行旁流EtCO₂监测可行性的研究。
一个为两个一级创伤中心服务的空中医疗转运项目。
在这项前瞻性观察研究中，对100例连续通过直升机转运的患者进行旁流EtCO₂监测。飞行护士对旁流监测的各种因素造成的困难进行评分。一名经验丰富的飞行护士和一名临床工程师评估波形和EtCO₂值。
100例转运患者中只有1例需要从旁流转为主流EtCO₂监测。两名患者的管道中出现水汽，其中一名改为主流监测。11例患者鼻孔堵塞，但未改为主流监测。在5分制李克特量表上，关于管道长度困难、患者耐受性以及对患者护理干扰的陈述的回答平均得分为0.5（范围为0 - 3）。关于固定套管困难的回答平均得分为0.7（范围为0 - 3）。在记录的1685个（99%）EtCO₂值中，1668个符合预先设定的“一致”标准。飞行护士在94例患者波形中的81例（86%）中识别出肺泡平台，临床工程师在94例患者波形中的73例（78%）中识别出肺泡平台。
在对气管插管和非气管插管患者进行空中医疗转运期间，旁流EtCO₂监测是可行的。该装置易于使用，并且在大多数读数中获得了一致的数值和带有肺泡平台的波形。
