Document Detail


Transcutaneous monitoring as a replacement for arterial PCO(2) monitoring during nocturnal non-invasive ventilation.
MedLine Citation:
PMID:  21030230     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Continuous, non-invasive assessment of alveolar ventilation achieved by transcutaneous PCO(2) (PtcCO(2)) monitoring is clearly superior to intermittent, invasive blood gas analyses in patients receiving nocturnal non-invasive positive pressure ventilation (NPPV), but the reliability and accuracy of PtcCO(2)-monitoring is still disputed. The present study was aimed at investigating the capability of modern PtcCO(2)-monitoring to reliably assess alveolar ventilation during nocturnal NPPV.
METHODS: Capillary blood gas measurements (11pm, 2am, 5am and 7am) and 8 h of continuous PtcCO(2)-monitoring using three of the latest generation devices (SenTec Digital Monitor, Radiometer TCM4-TINA and Radiometer TOSCA500) were performed during polysomnography-proven sleep studies in 24 patients receiving NPPV (15 with COPD, 9 with restrictive disorders).
RESULTS: The technical calibration drift for SenTec DM, TCM4-TINA and TOSCA500 was 0.1, -0.4 and -0.5 mmHg/h, respectively. Bland-Altman method comparison of PaCO(2)/drift-uncorrected PtcCO(2) revealed a mean bias (limits of agreement) of 1.0 (-4.7 to 6.7), -1.5 (-15.6 to 12.5) and 0.8 (-6.8 to 8.3) mmHg, respectively. Continuous overnight PtcCO(2)-monitoring detected variations in alveolar ventilation, with median ranges of 12.3 (10.7-14.5) mmHg for SenTec DM, 14.5 (12.5-17.0) mmHg for TCM4-TINA and 11.5 (11.0-13.0) mmHg for TOSCA500 (RM-ANOVA, p < 0.001). The four capillary PaCO(2) values ranged by a median of 6.3 (4.7-9.7) mmHg.
CONCLUSIONS: Modern PtcCO(2)-monitoring is reliable, accurate and robust. Since PtcCO(2)-monitoring is also non-invasive, does not disrupt sleep quality and provides a more complete picture of alveolar ventilation than intermittent capillary PaCO(2), PtcCO(2)-monitoring should become the preferred technique for assessing alveolar ventilation during nocturnal NPPV.
TRIAL REGISTRATION: DRKS00000433 at http://apps.who.int/trialsearch/default.aspx.
Authors:
Jan Hendrik Storre; Friederike Sophie Magnet; Michael Dreher; Wolfram Windisch
Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2010-10-28
Journal Detail:
Title:  Respiratory medicine     Volume:  105     ISSN:  1532-3064     ISO Abbreviation:  Respir Med     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-14     Completed Date:  2011-04-25     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  8908438     Medline TA:  Respir Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  143-50     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier Ltd. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Analysis of Variance
Biological Markers / blood
Blood Gas Monitoring, Transcutaneous / methods*
Calibration
Carbon Dioxide / blood*
Female
Humans
Male
Middle Aged
Polysomnography
Positive-Pressure Respiration / methods*
Sleep
Chemical
Reg. No./Substance:
0/Biological Markers; 142M471B3J/Carbon Dioxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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