title: Continuous carbon dioxide partial pressure monitoring in lung transplant recipients.
abstract: BACKGROUND
  Living-donor lobar lung transplantation (LDLLT) recipients often have hypercapnia preoperatively, which confers a risk of worsened hypercapnia intraoperatively. We reviewed our experience with continuous carbon dioxide partial pressure (PtcCO2) monitoring in LDLLT to evaluate its accuracy and feasibility. We also assessed preoperative and intraoperative carbon dioxide levels in LDLLT recipients.
  
  
  METHODS
  Twenty-six LDLLT recipients without pulmonary hypertension underwent preoperative nocturnal and intraoperative PtcCO2 monitoring, determined with a TOSCA-500 monitor.
  
  
  RESULTS
  Maximal preoperative nocturnal PtcCO2 (72.7 ± 19.3 mmHg) was significantly correlated with preoperative resting arterial carbon dioxide partial pressure (PaCO2; 55.1 ± 11.6 mmHg, r(2)=0.84). PtcCO2 was more correlated with PaCO2 (range, 39-192 mmHg) during LDLLT (r(2)=0.93) than with end-tidal carbon dioxide partial pressure (r(2)=0.38). Intraoperative continuous PtcCO2 monitoring was useful for evaluating real-time carbon dioxide levels. Intraoperative PtcCO2 did not exceed maximal preoperative nocturnal PtcCO2 in 13 recipients (50%) but temporarily exceeded it in 11 recipients (42%). PtcCO2 was further elevated in 2 recipients (8%) requiring the early establishment of cardiopulmonary bypass. There were no complications related to PtcCO2 monitoring.
  
  
  CONCLUSIONS
  PtcCO2 monitoring in LDLLT recipients is useful as a means for determining intraoperative carbon dioxide levels, which increase dramatically and can be predicted preoperatively and assessed in a timely manner.
authors.affiliation: Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Fengshi
authors.initials: F
authors.lastname: Chen
authors.affiliation: Department of Respiratory Care and Sleep Control Medicine, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Chin
authors.affiliation: Department of Anesthesiology, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Hisanari
authors.initials: H
authors.lastname: Ishii
authors.affiliation: Division of Medical Equipment, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kubo
authors.affiliation: Department of Cardiovascular Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Senri
authors.initials: S
authors.lastname: Miwa
authors.affiliation: Department of Cardiovascular Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Bando
authors.affiliation: Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date
mesh_terms: D000328:Adult; D002245:Carbon Dioxide / Q000097:blood / Q000502:physiology*; D002648:Child; D005260:Female; D006801:Humans; D019520:Living Donors; D016040:Lung Transplantation; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D010313:Partial Pressure; D057234:Preoperative Period; D012189:Retrospective Studies; D066027:Transplant Recipients
chemical_list: D002245:Carbon Dioxide