Transcutaneous carbon dioxide pressure monitoring in a specialized weaning unit.
OBJECTIVE
To evaluate transcutaneously measured P(CO(2)) (P(tcCO(2))) values during ventilator weaning and during bronchoscopies on ventilated patients, and to compare P(tcCO(2)) values to P(aCO(2)) values from arterial blood analysis and end-tidal P(CO(2)) (P(ETCO(2))) values from capnography.


METHODS
In our specialized weaning unit we measured P(tcCO(2)) in tracheostomized patients with prolonged weaning failure during daytime spontaneous breathing trials (SBTs) (23 measurement sessions in 15 patients), during their first nights off the ventilator (12 measurement sessions in 12 patients), during bronchoscopy while ventilated (80 measurement sessions in 21 patients), simultaneous with arterial blood draw for blood gas analysis (48 measurements in 38 patients), and simultaneous with P(ETCO(2)) measurements (39 measurements in 31 patients).


RESULTS
There were often large changes (> 10 mm Hg) in P(tcCO(2)) during daytime SBTs (23%) and the initial overnight off-the-ventilator periods (42%), which influenced the decisions of whether to continue the SBT. P(tcCO(2)) often rose during bronchoscopy (mean +/- SD increase of 10.7 +/- 5.8 mm Hg), which influenced the physician to change the ventilator settings 44% of the time. P(aCO(2)) closely matched P(tcCO(2)) (mean +/- SD difference of 0.5 +/- 4.1 mm Hg). There was a greater difference between P(aCO(2)) and P(ETCO(2)) (3.7 +/- 7.7 mm Hg during prolonged exhalation, and 6.8 +/- 7.2 mm Hg during tidal breathing).


CONCLUSIONS
Monitoring P(tcCO(2)) is very helpful in assessing and managing patients undergoing SBTs, during the first night off the ventilator, and during bronchoscopy on ventilated patients. P(tcCO(2)) more closely matches P(aCO(2)) than does P(ETCO(2)).
Johnson
Douglas C
DC
Spaulding Rehabilitation Hospital, 125 Nashua Street, Boston MA 02114, USA. djohnson5@partners.org
Batool
Salma
S
Dalbec
Ronald
R
D000368:Aged; D001785:Blood Gas Monitoring, Transcutaneous / Q000379:methods*; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011650:Pulmonary Alveoli / Q000503:physiopathology; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000628:therapy; D012123:Pulmonary Ventilation; D015203:Reproducibility of Results; D015300:Ventilator Weaning / Q000379:methods*