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Original Research: CRITICAL CARE MEDICINE |

Transcutaneous Pco2 Monitoring During Initiation of Noninvasive Ventilation*

Jan H. Storre, MD; Boris Steurer, MD; Hans-Joachim Kabitz, MD; Michael Dreher, MD; Wolfram Windisch, MD
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*From the Department of Pneumology, University Hospital Freiburg, Freiburg, Germany.

Correspondence to: Wolfram Windisch, MD, Department of Pneumology, University Hospital Freiburg, Killianstrasse 5, D-79106 Freiburg, Germany; e-mail: wolfram.windisch@uniklinik-freiburg.de



Chest. 2007;132(6):1810-1816. doi:10.1378/chest.07-1173
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Background: To assess the efficacy of transcutaneous Pco2 (Ptcco2) measurements for monitoring alveolar ventilation in patients requiring noninvasive positive-pressure ventilation (NPPV).

Methods: In a prospective study on method agreement pairs of Paco2 and Ptcco2 (SenTec Digital Monitor; SenTec AG; Therwil, Switzerland), measurements were performed every 10 min during the establishment of NPPV over a 4-h period in 10 patients (8 patients with COPD) presenting with acute-on-chronic hypercapnic respiratory failure, thus providing 250 pairs of measurement.

Results: Mean (± SD) Paco2 decreased from 67.2 ± 11.9 mm Hg (Ptcco2, 65.5 ± 13.9 mm Hg) to 54.6 ± 8.8 mm Hg (Ptcco2, 47.8 ± 8.8 mm Hg), and mean pH increased from 7.36 ± 0.03 to 7.44 ± 0.04. Following Ptcco2 assessment, Ptcco2 in the ensuing 2-min period was the strongest predictor for Paco2 compared to Ptcco2 in the ensuing 5-min period and to real-time measurements. Ptcco2 was highly correlated with Paco2 (r = 0.916; p < 0.001), as determined by linear regression analysis. The mean difference between Paco2 and Ptcco2 was 4.6 mm Hg, and the limits of agreement (bias ± 1.96 SDs) ranged from –3.9 to 13.2 mm Hg, following the Bland and Altman analysis. Retrospective drift correction produced an even higher correlation (r = 0.956; p < 0.001) with lower limits of agreement (–1.7 to 7.5 mm Hg).

Conclusions: Ptcco2 measurements provide a sensitive, continuous, and noninvasive method for monitoring alveolar ventilation in patients who are receiving short-term NPPV therapy. Drift correction of Ptcco2 measurements improves the accuracy of Ptcco2 monitoring compared to the “gold standard” Paco2 assessment. A lag time of approximately 2 min is present for reliable Ptcco2 values compared to Paco2 values. However, individual variance between Paco2 and Ptcco2 cannot be excluded.

Trial registration: www.uniklinik-freiburg.de/zks/live/uklregister/Oeffentlich.html Identifier:UKF001271.

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