Magnet F S, Windisch W, Storre J H
Fakultät für Gesundheit/Department für Humanmedizin, Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland.
Abteilung Pneumologie, Universitätsklinikum Freiburg im Breisgau, Freiburg im Breisgau, Deutschland.
Med Klin Intensivmed Notfmed. 2016 Apr;111(3):202-7. doi: 10.1007/s00063-016-0150-3. Epub 2016 Apr 5.
Respiratory insufficiency type 2 (ventilatory failure) is characterized by hypercapnia due to alveolar hypoventilation. Therefore, the monitoring of pCO2 is essential for diagnostic and surveillance purposes. Various techniques which differ in the way of measurement (e.g., invasive/noninvasive, continuous/noncontinuous) and their indication are available. Arterial blood gas analysis (ABG) as an invasive procedure is the gold standard procedure and is mostly used in emergency medicine or intensive care units (ICUs). Another method to evaluate pCO2 is capillary blood gas analysis (CBG). Furthermore, endtidal pCO2-(PetCO2) and transcutaneous CO2-measurement (PtcCO2) are able to continuously and noninvasively monitor pCO2. PetCO2 is mostly used in the field of anesthesiology during general anesthesia and is integrated in many ventilators, also in ICUs. However, PetCO2 is limited in monitoring pCO2 in patients with lung disease and it is only reasonably usable in invasively ventilated patients. Transcutaneous pCO2 (PtcCO2) is available as an alternative, especially in chronic respiratory failure and to diagnose hypoventilation in sleep-related breathing disorders, and it has substantial advantages in these indications compared to discontinuous measurements, e.g., blood gas analysis. The various methods to monitor pCO2 are generally used synergistically in clinical practice.
2型呼吸功能不全(通气衰竭)的特征是由于肺泡通气不足导致的高碳酸血症。因此,监测pCO2对于诊断和监测目的至关重要。有多种测量方法不同(例如,有创/无创、连续/非连续)及其适用情况的技术可供使用。动脉血气分析(ABG)作为一种有创检查方法是金标准方法,主要用于急诊医学或重症监护病房(ICU)。另一种评估pCO2的方法是毛细血管血气分析(CBG)。此外,呼气末二氧化碳分压(PetCO2)和经皮二氧化碳测量(PtcCO2)能够连续且无创地监测pCO2。PetCO2主要用于全身麻醉期间的麻醉学领域,并且许多呼吸机中都有集成,在ICU中也如此。然而,PetCO2在监测肺部疾病患者的pCO2方面存在局限性,并且仅适用于有创通气的患者。经皮二氧化碳(PtcCO2)可作为一种替代方法,特别是在慢性呼吸衰竭以及诊断睡眠相关呼吸障碍中的通气不足时,并且与间断测量(例如血气分析)相比,它在这些适用情况中具有显著优势。在临床实践中,通常协同使用多种监测pCO2的方法。