Palmon S C, Liu M, Moore L E, Kirsch J R
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Crit Care Med. 1996 Apr;24(4):608-11. doi: 10.1097/00003246-199604000-00010.
We tested the hypothesis that Paco2 would be more tightly controlled if end-tidal CO2 monitoring was used during hand ventilation for transport of intubated patients.
Randomized, prospective analysis of the no-monitor and monitor-blind groups (the monitor was on the bed during transport but only the investigator was aware of the end-tidal CO2 values). Nonrandomized, prospective analysis of the monitor group (ventilation controlled using end-tidal CO2 value from monitor).
University hospital operating room and intensive care unit (ICU).
Fifty intubated patients who were transported from the operating room to the ICU or from the ICU to the neuroradiology suite were assigned randomly to one of two groups: a) no-monitor group (n = 25); and b) monitor-blind group (n = 25). An additional group (monitor group, n = 10) was subsequently added to the study.
Capnography was instituted in all patients in a blocked fashion.
Arterial blood gases and end-tidal CO2 values were measured before and after transport. When comparing overall group data, pre- and post-Paco2 values were similar: monitor 39 +/- 2 vs. 41 +/- 2 torr (5.2 +/- 0.3 vs. 5.5 +/- 0.3 no-monitor 39 +/- 1 vs. 37 +/- torr (5.2 +/- 0.1 vs. 5.0 +/- 0.1 kPa). However, when comparing Paco2 values for individual patients, we found that there was significantly greater variability for Paco2 after transport when end-tidal CO2 was not used for control of ventilation during transport.
These data do not support routine monitoring of end-tidal CO2 during short transport times in adult patients requiring mechanical ventilation. However, the monitor may prevent morbidity in patients requiring tight control of Paco2.
我们检验了这样一个假设，即在对气管插管患者进行转运的手动通气过程中，若使用呼气末二氧化碳监测，则动脉血二氧化碳分压（Paco2）能得到更严格的控制。
对无监测组和监测盲组进行随机、前瞻性分析（监测仪在转运过程中置于床上，但只有研究者知晓呼气末二氧化碳值）。对监测组进行非随机、前瞻性分析（使用监测仪的呼气末二氧化碳值来控制通气）。
大学医院手术室和重症监护病房（ICU）。
50例从手术室转运至ICU或从ICU转运至神经放射科的气管插管患者被随机分为两组：a）无监测组（n = 25）；b）监测盲组（n = 25）。随后又有一组（监测组，n = 10）加入该研究。
以分组的方式对所有患者进行二氧化碳波形图监测。
在转运前后测量动脉血气和呼气末二氧化碳值。比较总体组数据时，转运前后的Paco2值相似：监测组为39±2 vs. 41±2托（5.2±0.3 vs. 5.5±0.3千帕），无监测组为39±1 vs. 37±托（5.2±0.1 vs. 5.0±0.1千帕）。然而，在比较个体患者的Paco2值时，我们发现，在转运过程中若不使用呼气末二氧化碳来控制通气，则转运后Paco2的变异性显著更大。
这些数据不支持在需要机械通气的成年患者短时间转运期间常规监测呼气末二氧化碳。然而，监测仪可能会预防需要严格控制Paco2的患者出现并发症。
