使用鼻颊传感器进行呼气末二氧化碳监测不适用于无创通气期间的二氧化碳监测。
End-tidal carbon dioxide monitoring using a naso-buccal sensor is not appropriate to monitor capnia during non-invasive ventilation.
作者信息
Piquilloud Lise, Thevoz David, Jolliet Philippe, Revelly Jean-Pierre
机构信息
Adult Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland.
Adult Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland ; Cardio-Respiratory Physiotherapy Unit, University Hospital of Lausanne, Lausanne, Switzerland.
出版信息
Ann Intensive Care. 2015 Feb 12;5:2. doi: 10.1186/s13613-014-0042-8. eCollection 2015.
BACKGROUND
In acute respiratory failure, arterial blood gas analysis (ABG) is used to diagnose hypercapnia. Once non-invasive ventilation (NIV) is initiated, ABG should at least be repeated within 1 h to assess PaCO2 response to treatment in order to help detect NIV failure. The main aim of this study was to assess whether measuring end-tidal CO2 (EtCO2) with a dedicated naso-buccal sensor during NIV could predict PaCO2 variation and/or PaCO2 absolute values. The additional aim was to assess whether active or passive prolonged expiratory maneuvers could improve the agreement between expiratory CO2 and PaCO2.
METHODS
This is a prospective study in adult patients suffering from acute hypercapnic respiratory failure (PaCO2 ≥ 45 mmHg) treated with NIV. EtCO2 and expiratory CO2 values during active and passive expiratory maneuvers were measured using a dedicated naso-buccal sensor and compared to concomitant PaCO2 values. The agreement between two consecutive values of EtCO2 (delta EtCO2) and two consecutive values of PaCO2 (delta PaCO2) and between PaCO2 and concomitant expiratory CO2 values was assessed using the Bland and Altman method adjusted for the effects of repeated measurements.
RESULTS
Fifty-four datasets from a population of 11 patients (8 COPD and 3 non-COPD patients), were included in the analysis. PaCO2 values ranged from 39 to 80 mmHg, and EtCO2 from 12 to 68 mmHg. In the observed agreement between delta EtCO2 and deltaPaCO2, bias was -0.3 mmHg, and limits of agreement were -17.8 and 17.2 mmHg. In agreement between PaCO2 and EtCO2, bias was 14.7 mmHg, and limits of agreement were -6.6 and 36.1 mmHg. Adding active and passive expiration maneuvers did not improve PaCO2 prediction.
CONCLUSIONS
During NIV delivered for acute hypercapnic respiratory failure, measuring EtCO2 using a dedicating naso-buccal sensor was inaccurate to predict both PaCO2 and PaCO2 variations over time. Active and passive expiration maneuvers did not improve PaCO2 prediction.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT01489150.
背景
在急性呼吸衰竭中，动脉血气分析（ABG）用于诊断高碳酸血症。一旦开始无创通气（NIV），应至少在1小时内重复进行ABG检查，以评估PaCO2对治疗的反应，从而有助于检测NIV失败。本研究的主要目的是评估在NIV期间使用专用鼻颊传感器测量呼气末二氧化碳（EtCO2）是否可以预测PaCO2变化和/或PaCO2绝对值。额外目的是评估主动或被动延长呼气动作是否可以改善呼气二氧化碳与PaCO2之间的一致性。
方法
这是一项对接受NIV治疗的急性高碳酸血症呼吸衰竭（PaCO2≥45 mmHg）成年患者的前瞻性研究。使用专用鼻颊传感器测量主动和被动呼气动作期间的EtCO2和呼气二氧化碳值，并与同时测量的PaCO2值进行比较。使用针对重复测量效应进行调整的Bland和Altman方法评估EtCO2的两个连续值（δEtCO2）和PaCO2的两个连续值（δPaCO2）之间以及PaCO2与同时测量的呼气二氧化碳值之间的一致性。
结果
分析纳入了来自11名患者（8名慢性阻塞性肺疾病（COPD）患者和3名非COPD患者）群体的54个数据集。PaCO2值范围为39至80 mmHg，EtCO2值范围为12至68 mmHg。在观察到的δEtCO2与δPaCO2之间的一致性中，偏差为 -0.3 mmHg，一致性界限为 -17.8和17.2 mmHg。在PaCO2与EtCO2之间的一致性中，偏差为14.7 mmHg，一致性界限为 -6.6和36.1 mmHg。添加主动和被动呼气动作并未改善PaCO2预测。
结论
在为急性高碳酸血症呼吸衰竭进行NIV期间，使用专用鼻颊传感器测量EtCO2来预测PaCO2及其随时间的变化是不准确的。主动和被动呼气动作并未改善PaCO2预测。
试验注册
ClinicalTrials.gov：NCT01489150。
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