Monitoring Transcutaneously Measured Partial Pressure of CO2 During Intubation in Critically Ill Subjects.
Background: The risk for severe hypoxemia during endotracheal intubation is a major concern in the ICU, but little attention has been paid to CO2 variability. The objective of this study was to assess transcutaneously measured partial pressure of CO2 ([Formula: see text]) throughout intubation in su...
| Published in: | Respiratory Care Vol. 66; no. 6; pp. 1004 - 1016 |
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| Main Authors: | , , , , , , , , , , , |
| Format: | research tables/charts Journal Article |
| Published: |
Mary Ann Liebert, Inc.
Jun2021
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=150953544&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 150953544 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Jun2021 vid: 66 iid: 6 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 150953544 150953544 150953544 10.4187/respcare.08009 150953544 ppf: 1004 ppct: 12 formats: fmt: @attributes: type: P tig: atl: Monitoring Transcutaneously Measured Partial Pressure of CO2 During Intubation in Critically Ill Subjects. aug: au: Frérou, Aurélien Maamar, Adel Rafi, Sonia Lhommet, Claire Phelouzat, Pierre Pontis, Emmanuel Reizine, Florian Lesouhaitier, Mathieu Camus, Christophe Le Tulzo, Yves Tadié, Jean-Marc Gacouin, Arnaud affil: Service de Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France sug: subj: Carbon Dioxide Analysis Capnography Methods Intubation Critically Ill Patients Blood Gas Monitoring, Transcutaneous Human Prospective Studies Nonexperimental Studies Respiration, Artificial Oxygenation Descriptive Statistics Confidence Intervals Hypotension ab: Background: The risk for severe hypoxemia during endotracheal intubation is a major concern in the ICU, but little attention has been paid to CO2 variability. The objective of this study was to assess transcutaneously measured partial pressure of CO2 ([Formula: see text]) throughout intubation in subjects in the ICU who received standard oxygen therapy, high-flow nasal cannula oxygen therapy, or noninvasive ventilation for preoxygenation. We hypothesized that the 3 methods differ in terms of ventilation and CO2 removal. Methods: In this single-center, prospective, observational study, we recorded [Formula: see text] from preoxygenation to 3 h after the initiation of mechanical ventilation among subjects requiring endotracheal intubation. Subjects were sorted into 3 groups according to the preoxygenation method. We then assessed the link between [Formula: see text] variability and the development of postintubation hypotension. Results: A total of 202 subjects were included in the study. The [Formula: see text] values recorded at endotracheal intubation, at the initiation of mechanical ventilation, and after 30 min and 1 h of mechanical ventilation were significantly higher than those recorded during preoxygenation (P < .05). [Formula: see text] variability differed significantly according to the preoxygenation method (P < .001, linear mixed model). A decrease in [Formula: see text] by > 5 mm Hg within 30 min after the start of mechanical ventilation was independently associated with postintubation hypotension (odds ratio = 2.14 [95% CI 1.03-4.44], P = .039) after adjustments for age, Simplified Acute Physiology Score II, COPD, cardiac comorbidity, the use of propofol for anesthetic induction, and minute ventilation at the start of mechanical ventilation. Conclusions: [Formula: see text] variability during intubation is significant and differs with the method of preoxygenation. A decrease in [Formula: see text] after the beginning of mechanical ventilation was associated with postintubation hypotension. (ClinicalTrials.gov registration NCT0388430.). pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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