Accuracy of a transcutaneous carbon dioxide pressure monitoring device in emergency room patients with acute respiratory failure.
OBJECTIVE
Transcutaneous CO(2) monitors are widely used in neonatal ICUs. Until recently, these devices performed poorly in adults. Recent technical modifications have produced transcutaneous CO(2) monitors that have performed well in adults with chronic illnesses. We evaluated the accuracy of one of these devices, the TOSCA(®) 500, in adults admitted to an emergency department for acute respiratory failure.


METHODS
We prospectively collected 29 pairs of simultaneous transcutaneous arterial CO(2) (PtcCO(2)) and arterial CO(2) (PaCO(2)) values in 21 consecutive adults with acute respiratory failure (acute heart failure, n = 6; COPD exacerbation, n = 8; acute pneumonia, n = 6; and pulmonary embolism, n = 1). Agreement between PaCO(2) and PtcCO(2) was evaluated using the Bland-Altman method.


RESULTS
Mean arterial oxygen saturation was 90%, arterial oxygen tension ranged from 32 to 215 mmHg, and PaCO(2) ranged from 23 to 84 mmHg. The mean difference between PaCO(2) and PtcCO(2) was 0.1 mmHg, and the Bland-Altman limits of agreement (bias ± 1.96 SD) ranged from -6 to 6.2 mmHg. None of the patients experienced adverse effects from heating of the device clipped to the earlobe.


CONCLUSIONS
PtcCO(2) showed good agreement with PaCO(2) in adults with acute respiratory failure.
Département d'Accueil et de Traitement des Urgences, CHU de Caen, 14000 Caen, France. gancel-pe@chu-caen.fr
P-E
PE
Gancel
E
E
Roupie
L
L
Guittet
S
S
Laplume
N
N
Terzi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001785:Blood Gas Monitoring, Transcutaneous / Q000592:standards*; D002245:Carbon Dioxide / Q000097:blood*; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012128:Respiratory Distress Syndrome / Q000097:blood*
D002245:Carbon Dioxide