Department of Home Mechanical Ventilation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. a.hazenberg@ long.umcg.nl
Respiration. 2011;81(3):242-6. doi: 10.1159/000323074. Epub 2011 Jan 15.
Home mechanical ventilation is usually started in hospital as arterial blood gas sampling is deemed necessary to monitor CO(2) and O(2) adequately during institution of ventilatory support. A non-invasive device to reliably measure CO(2) transcutaneously would alleviate the need for high care settings for measurement and open the possibility for home registration.
In this study we investigated whether the TOSCA® transcutaneous CO(2) (PtcCO(2)) measurements, performed continuously during the night, reliably reflect arterial CO(2) (PaCO(2)) measurements in adults with chronic respiratory failure.
Paired measurements were taken in 15 patients hospitalised to evaluate their blood gas exchange. Outcomes were compared 30 min, 2, 4, 6 and 8 h after attaching the sensor to the earlobe. A maximum difference of 1.0 kPa and 95% limits of agreement (LOA) of 1 kPa between CO(2) pressure measurements, following the analysis by Bland and Altman, were determined as acceptable.
Mean PtcCO(2) was 0.4 kPa higher (LOA -0.48 to 1.27 kPa) than mean PaCO(2) after 30 min. These figures were 0.6 kPa higher (LOA -0.60 to 1.80 kPa) after 4 h, with a maximum of 0.72 kPa (LOA 0.35 to 1.79 kPa) after 8 h. The corresponding values for changes in PtcCO(2) versus PaCO(2) were not significant (ANOVA).
PtcCO(2) measurement, using TOSCA, is a valid method showing an acceptable agreement with PaCO(2) during 8 h of continuous measurement. Therefore, this device can be used to monitor CO(2) adequately during chronic ventilatory support.
家庭机械通气通常在医院开始，因为在开始通气支持时，需要进行动脉血气采样以充分监测 CO(2) 和 O(2)。一种可靠地经皮测量 CO(2) 的非侵入性设备将减轻对高护理环境进行测量的需求，并为家庭登记开辟可能性。
在这项研究中，我们调查了 TOSCA®经皮 CO(2) (PtcCO(2))测量值在夜间连续测量时，是否能可靠地反映慢性呼吸衰竭成人的动脉 CO(2) (PaCO(2))测量值。
对 15 名住院患者进行了配对测量，以评估其血气交换。在将传感器贴于耳廓后 30 分钟、2、4、6 和 8 小时，比较了测量结果。根据 Bland 和 Altman 的分析，确定了 CO(2)压力测量值之间最大差异为 1.0 kPa 和 95%一致性界限 (LOA) 为 1 kPa，为可接受值。
在 30 分钟后，平均 PtcCO(2)比平均 PaCO(2)高 0.4 kPa (LOA -0.48 至 1.27 kPa)。在 4 小时后，这些数字高 0.6 kPa (LOA -0.60 至 1.80 kPa)，8 小时后最高为 0.72 kPa (LOA 0.35 至 1.79 kPa)。PtcCO(2)与 PaCO(2)变化的相应值没有统计学意义 (ANOVA)。
使用 TOSCA 的 PtcCO(2)测量是一种有效的方法，在 8 小时的连续测量中显示出与 PaCO(2)的可接受一致性。因此，该设备可用于在慢性通气支持期间充分监测 CO(2)。
