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Sen B, Panidapu N, Micka R, Neema PK. Use of Capnography to Identify a Malpositioned Double-Lumen Endotracheal Tube. J Cardiothorac Vasc Anesth 2024; 38:1287-1288. [PMID: 38378319 DOI: 10.1053/j.jvca.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Barsha Sen
- Department of Cardiac Anesthesiology, Amrita Institute of Medical Sciences, Kochi, India
| | - Nagarjuna Panidapu
- Department of Cardiac Anesthesiology, Amrita Institute of Medical Sciences, Kochi, India.
| | - Rohik Micka
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences, Kochi, India
| | - Praveen Kumar Neema
- Department of Cardiac Anesthesiology, Amrita Institute of Medical Sciences, Kochi, India
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López-Izquierdo R, Zalama-Sánchez D, Rodrigo Enríquez DSG, Ana Ramos R, Laura Fadrique M, Mario Rodil M, Virginia Carbajosa R, Rubén Pérez G, Sanz-García A, Del Pozo Vegas C, Martín-Rodríguez F. Utility of non-invasive monitoring of exhaled carbon dioxide and perfusion index in adult patients in the emergency department. Am J Emerg Med 2024; 79:85-90. [PMID: 38401230 DOI: 10.1016/j.ajem.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/23/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Several noninvasive solutions are available for the assessment of patients at risk of deterioration. Capnography, in the form of end-tidal exhaled CO2 (ETCO2) and perfusion index (PI), could provide relevant information about patient prognosis. The aim of the present project was to determine the association of ETCO2 and PI with mortality of patients admitted to the emergency department (ED). METHODS Multicenter, prospective, cohort study of adult patients with acute disease who needed continuous monitoring in the ED. The study included two tertiary hospitals in Spain between October 2022 and June 2023. The primary outcome of the study was in-hospital mortality (all-cause). Demographics, vital signs, ETCO2 and PI were collected. RESULTS A total of 687 patients were included in the study. The in-hospital mortality rate was 6.8%. The median age was 79 years (IQR: 69-86), and 63.3% were males. The median ETCO2 value was 30 mmHg (26-35) in survivors and 23 mmHg (16-30) in nonsurvivors (p = 0.001). For the PI, the medians were 4.7% (2.8-8.1) for survivors and 2.5% (0.98-4-4) for nonsurvivors (p < 0.001). The model that presented the best AUC was age (odds ratio (OR): 1.02 (1.00-1.05)), the respiratory rate (OR: 1.06 (1.02-1.11)), and the PI (OR: 0.83 (0.75-0.91)), with a result of 0.840 (95% CI: 0.795-0.886); the model with the respiratory rate (OR: 1.05 (1.01-1.10)), the PI (OR: 0.84 (0.76-0.93)), and the ETCO2 (no statistically significant OR), with an AUC of 0.838 (95% CI: 0.787-0.889). CONCLUSIONS The present study showed that the PI and respiratory rate are independently associated with in-hospital mortality. Both the PI and ETCO2 are predictive parameters with improved prognostic performance compared with that of standard vital signs.
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Affiliation(s)
- Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain; Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | | | | | | | | | - Muñoz Mario Rodil
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | - García Rubén Pérez
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain.
| | - Carlos Del Pozo Vegas
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Emergency Department, Hospital Clínico Universitario. Valladolid, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
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De Meyer GRA, Morrison SG, Schepens T. Validity of volumetric capnography for the quantification of dead space during flow-controlled ventilation with active expiratory flow. Eur J Anaesthesiol 2024; 41:316-319. [PMID: 37982584 DOI: 10.1097/eja.0000000000001931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Affiliation(s)
- Gregory R A De Meyer
- From the Department of Anesthesia (GRADM, SGM), Department of Critical Care Medicine, Antwerp University Hospital, Edegem (GRADM), Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (GRADM), Department of Intensive Care Medicine, Ghent University Hospital (TS) and Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium (TS)
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Williams EE, Bednarczuk N, Nanjundappa M, Greenough A, Dassios T. Monitoring persistent pulmonary hypertension of the newborn using the arterial to end tidal carbon dioxide gradient. J Clin Monit Comput 2024; 38:463-467. [PMID: 38150123 PMCID: PMC10994866 DOI: 10.1007/s10877-023-01105-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/08/2023] [Indexed: 12/28/2023]
Abstract
Persistent pulmonary hypertension of the newborn (PPHN) can be monitored theoretically by the difference of the partial pressure of arterial (PaCO2) to end-tidal CO2 (EtCO2). We aimed to test the hypothesis that the PaCO2-EtCO2 gradient in infants with PPHN would be higher compared to infants without PPHN. Prospective, observational study of term-born ventilated infants with echocardiographically-confirmed PPHN with right-to-left shunting and term-born control infants without respiratory disease. The PaCO2-EtCO2 gradient was calculated as the difference between the PaCO2 measured from indwelling arterial sample lines and EtCO2 measured by continuous Microstream sidestream capnography. Twenty infants (9 with PPHN and 11 controls) were studied with a median (IQR) gestational age of 39.5 (38.7-40.4) weeks, a birthweight of 3.56 (3.15-3.93) kg and a birthweight z-score of 0.03 (- 0.91 to 1.08). The PaCO2-EtCO2 gradient was larger in the infants with PPHN compared to those without PPHN after adjusting for differences in the mean airway pressure and fraction of inspired oxygen (adjusted p = 0.037). In the infants with PPHN the median PaCO2-EtCO2 gradient decreased from 10.7 mmHg during the acute illness to 3.3 mmHg pre-extubation. The median difference in the gradient was significantly higher in infants with PPHN (6.2 mmHg) compared to infants without PPHN (-3.2 mmHg, p = 0.022). The PaCO2-EtCO2 gradient was higher in infants with PPHN compared to term born infants without PPHN and decreased over the first week of life in infants with PPHN. The gradient might be utilised to monitor the evolution and resolution of PPHN.
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Affiliation(s)
- Emma E Williams
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nadja Bednarczuk
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Anne Greenough
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Theodore Dassios
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
- Neonatal Intensive Care Unit, University of Patras, Patras, Greece.
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Arslan S, Guçlu Utlu S, Gucal R, Akpinar F, Doru HI, Zengin O, Çirçir MN, Can NO. The utility of capnography in determining the risk of major cardiac adverse events in patients with atypical chest pain. Int Emerg Nurs 2024; 73:101417. [PMID: 38330517 DOI: 10.1016/j.ienj.2024.101417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/15/2024] [Accepted: 01/27/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Various scoring systems have been developed to safely rule out the diagnosis of acute coronary syndrome. Furthermore, the efficacy of these scoring systems in predicting the risk of major adverse cardiac events (MACE) is debated. Our aim was to compare parameters such as Integrated Pulmonary Index (IPI) and End Tidal Carbon Dioxide (etCO2) measured in the emergency department with the HEART score in terms of its success in predicting the risk of major adverse cardiac events. METHOD Patients with atypical chest pain were registered for the study by the emergency room physician. The patients were investigated regarding gender, age, background characteristics, prognostic accuracy of etCO2, IPI, MACE, and HEART scores. RESULTS As a result of the analysis, higher HEART Score and lower etCO2 values were determined in the MACE group compared to the group without MACE. ROC analysis was performed to determine the power of IPI, HEART Score, and etCO2 to predict MACE. The findings revealed that IPI significantly predicted MACE with an AUC value of 0.737. CONCLUSION In our study, although the highest sensitivity values in determining the risk of 30-day MACE belonged to the HEART score, etCO2 and IPI might be other parameters that could be used to determine the risk of 30-day MACE.
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Affiliation(s)
- Senol Arslan
- Erzurum Regional Training and Research Hospital, Department of Emergency Medicine, Erzurum, Turkey.
| | - Sibel Guçlu Utlu
- Erzurum Regional Training and Research Hospital, Department of Emergency Medicine, Erzurum, Turkey.
| | - Rıza Gucal
- Erzurum Regional Training and Research Hospital, Department of Emergency Medicine, Erzurum, Turkey
| | - Furkan Akpinar
- Erzurum Regional Training and Research Hospital, Department of Emergency Medicine, Erzurum, Turkey.
| | - Halil Ibrahim Doru
- Erzurum Regional Training and Research Hospital, Department of Emergency Medicine, Erzurum, Turkey.
| | - Onur Zengin
- Erzurum Regional Training and Research Hospital, Department of Emergency Medicine, Erzurum, Turkey.
| | - Melike Nur Çirçir
- Erzurum Regional Training and Research Hospital, Department of Emergency Medicine, Erzurum, Turkey.
| | - Nazım Onur Can
- Erzurum Regional Training and Research Hospital, Department of Emergency Medicine, Erzurum, Turkey.
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Miller LA, Braun RK, Golding RJ, Lasarev M, Rodgers AC, El-Meanawy S, Hacker TA, Eldridge MW, Al-Subu AM. Indirect cardiac output assessment in a swine pediatric acute respiratory distress syndrome model. Respir Physiol Neurobiol 2024; 320:104199. [PMID: 38000708 DOI: 10.1016/j.resp.2023.104199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE To investigate the correlation between volume of carbon dioxide elimination (V̇CO2) and end-tidal carbon dioxide (PETCO2) with cardiac output (CO) in a swine pediatric acute respiratory distress syndrome (ARDS) model. METHODS Respiratory and hemodynamic variables were collected from twenty-six mechanically ventilated juvenile pigs under general anesthesia before and after inducing ARDS, using oleic acid infusion. RESULTS Prior to ARDS induction, mean (SD) CO, V̇CO2, PETCO2, and dead space to tidal volume ratio (Vd/Vt) were 4.16 (1.10) L/min, 103.69 (18.06) ml/min, 40.72 (3.88) mmHg and 0.25 (0.09) respectively. Partial correlation coefficients between average CO, V̇CO2, and PETCO2 were 0.44 (95% confidence interval: 0.18-0.69) and 0.50 (0.18-0.74), respectively. After ARDS induction, mean CO, V̇CO2, PETCO2, and Vd/Vt were 3.33 (0.97) L/min, 113.71 (22.97) ml/min, 50.17 (9.73) mmHg and 0.40 (0.08). Partial correlations between CO and V̇CO2 was 0.01 (-0.31 to 0.37) and between CO and PETCO2 was 0.35 (-0.002 to 0.65). CONCLUSION ARDS may limit the utility of volumetric capnography to monitor CO.
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Affiliation(s)
- Lorenzo A Miller
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Rudolf K Braun
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | | | - Michael Lasarev
- Department of Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Allison C Rodgers
- Cardiovascular Physiology Core Facility, Department of Medicine, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Sarah El-Meanawy
- Cardiovascular Physiology Core Facility, Department of Medicine, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Timothy A Hacker
- Cardiovascular Physiology Core Facility, Department of Medicine, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Marlowe W Eldridge
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Awni M Al-Subu
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; UWHealth Kids American Family Children's Hospital, Madison, WI 53792, USA.
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Wham C, Morin T, Sauaia A, McIntyre R, Urban S, McVaney K, Cohen M, Cralley A, Moore EE, Campion EM. Prehospital ETCO 2 is predictive of death in intubated and non-intubated patients. Am J Surg 2023; 226:886-890. [PMID: 37563074 DOI: 10.1016/j.amjsurg.2023.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/18/2023] [Accepted: 07/22/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Prehospital identification of shock in trauma patients lacks accurate markers. Low end tidal carbon dioxide (ETCO2) correlates with mortality in intubated patients. The predictive value of ETCO2 obtained by nasal capnography cannula (NCC) is unknown. We hypothesized that prehospital ETCO2 values obtained by NCC and in-line ventilator circuit (ILVC) would be predictive of mortality. METHODS This was a prospective, observational, multicenter study. ETCO2 values were collected by a NCC or through ILVC. AUROCs were compared with prehospital systolic blood pressure (SBP) and shock index (SI). The Youden index defined optimal cutoffs. RESULTS Of 550 enrolled patients, 487 (88.5%) had ETCO2 measured through an NCC. Median age was 37 (27-52) years; 76.5% were male; median ISS was 13 (5-22). Mortality was 10.4%. Minimum prehospital ETCO2 significantly predicted mortality with an AUROC of 0.76 (CI 0.69-0.84; Youden index = 22 mmHg), outperforming SBP with an AUROC of 0.68; (CI 0.62-0.74, p = 0.04) and shock index with an AUROC of 0.67 (CI 0.59-0.74, p = 0.03). CONCLUSION Prehospital ETCO2 measured by non-invasive NCC or ILVC may be predictive of mortality in injured patients.
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Affiliation(s)
- Courtney Wham
- Denver Health Medical Center, Department of Emergency Medicine, Denver Paramedics, United States.
| | - Theresa Morin
- Ernest E. Moore Shock Trauma Center at Denver Health, Department of Surgery, United States.
| | - Angela Sauaia
- University of Colorado, School of Public Health (AS), United States.
| | - Robert McIntyre
- University of Colorado Anschutz, Department of Surgery, United States.
| | - Shane Urban
- University of Colorado Anschutz, Department of Surgery, United States.
| | - Kevin McVaney
- Denver Health Medical Center, Department of Emergency Medicine, Denver Paramedics, United States.
| | - Mitchell Cohen
- University of Colorado Anschutz, Department of Surgery, United States.
| | - Alexis Cralley
- Ernest E. Moore Shock Trauma Center at Denver Health, Department of Surgery, United States.
| | - Ernest E Moore
- Ernest E. Moore Shock Trauma Center at Denver Health, Department of Surgery, United States.
| | - Eric M Campion
- Ernest E. Moore Shock Trauma Center at Denver Health, Department of Surgery, United States.
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Snyder A, Binda D, Germany JL, Rosales V, Tan F, Nozari A, Ortega R. Capnography: Video in Clinical Anesthesia. Anesth Analg 2023; 137:943-946. [PMID: 37862393 DOI: 10.1213/ane.0000000000006684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Affiliation(s)
- Austin Snyder
- From the Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Norweg A, Hofferber B, Oh C, Spinner M, Stavrolakes K, Pavol M, DiMango A, Raveis VH, Murphy CG, Allegrante JP, Buchholz D, Zarate A, Simon N. Capnography-Assisted Learned, Monitored (CALM) breathing therapy for dysfunctional breathing in COPD: A bridge to pulmonary rehabilitation. Contemp Clin Trials 2023; 134:107340. [PMID: 37730198 DOI: 10.1016/j.cct.2023.107340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/20/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Although dyspnea is a primary symptom of chronic obstructive pulmonary disease (COPD), its treatment is suboptimal. In both COPD and acute anxiety, breathing patterns become dysregulated, contributing to abnormal CO2, dyspnea, and inefficient recovery from breathing challenges. While pulmonary rehabilitation (PR) improves dyspnea, only 1-2% of patients access it. Individuals with anxiety who use PR have worse outcomes. METHODS We present the protocol of a randomized controlled trial designed to determine the feasibility and acceptability of a new, four-week mind-body intervention that we developed, called "Capnography-Assisted Learned, Monitored (CALM) Breathing," as an adjunct to PR. Eligible participants are randomized in a 1:1 ratio to either CALM Breathing program or Usual Care. CALM Breathing consists of 10 core, slow breathing exercises combined with real time biofeedback (of end-tidal CO2, respiratory rate, and airflow) and motivational interviewing. CALM Breathing promotes self-regulated breathing, linking CO2 changes to dyspnea and anxiety symptoms and targeting breathing efficiency and self-efficacy in COPD. Participants are randomized to CALM Breathing or a Usual Care control group. RESULTS Primary outcomes include feasibility and acceptability metrics of recruitment efficiency, participant retention, intervention adherence and fidelity, PR facilitation, patient satisfaction, and favorable themes from interviews. Secondary outcomes include breathing biomarkers, symptoms, health-related quality of life, six-minute walk distance, lung function, mood, physical activity, and PR utilization and engagement. CONCLUSION By disrupting the cycle of dyspnea and anxiety, and providing a needed bridge to PR, CALM Breathing may address a substantive gap in healthcare and optimize treatment for patients with COPD.
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Affiliation(s)
- Anna Norweg
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA.
| | - Brittany Hofferber
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Cheongeun Oh
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Michael Spinner
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Kimberly Stavrolakes
- Outpatient Pulmonary Rehabilitation Program, New York Presbyterian Hospital, New York, NY, USA
| | - Marykay Pavol
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA; Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Angela DiMango
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Victoria H Raveis
- Department of Cariology and Comprehensive Care, College of Dentistry, New York University, New York, NY, USA
| | - Charles G Murphy
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - John P Allegrante
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, USA; Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David Buchholz
- Department of Primary Care, Columbia University Irving Medical Center, New York, NY, USA
| | - Alejandro Zarate
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Naomi Simon
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
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Nathan N. Closing the Capnography Gap: The Capnography Project. Anesth Analg 2023; 137:921. [PMID: 37862389 DOI: 10.1213/ane.0000000000006729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
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Campos MD, Palazzi LH, Böhm SH, Tusman G. Effects of apparatus dead space on volumetric capnograms in neonates with healthy lungs: a simulation study. Paediatr Anaesth 2023; 33:973-982. [PMID: 37403466 DOI: 10.1111/pan.14724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Volumetric capnography in healthy ventilated neonates showed deformed waveforms, which are supposedly due to technological limitations of flow and carbon dioxide sensors. AIMS This bench study analyzed the role of apparatus dead space on the shape of capnograms in simulated neonates with healthy lungs. METHODS We simulated mechanical breaths in neonates of 2, 2.5, and 3 kg of body weight using a neonatal volumetric capnography simulator. The simulator was fed by a fixed amount of carbon dioxide of 6 mL/kg/min. Such simulator was ventilated in a volume control mode using fixed ventilatory settings with a tidal volume of 8 mL/kg and respiratory rates of 40, 35, and 30 breaths per minute for the 2, 2.5 and 3 kg neonates, respectively. We tested the above baseline ventilation with and without an additional apparatus dead space of 4 mL. RESULTS Simulations showed that adding the apparatus dead space to baseline ventilation increased the amount of re-inhaled carbon dioxide in all neonates: 0.16 ± 0.01 to 0.32 ± 0.03 mL (2 kg), 0.14 ± 0.02 to 0.39 ± 0.05 mL (2.5 kg), and 0.13 ± 0.01 to 0.36 ± 0.05 mL (3 kg); (p < .001). Apparatus dead space was computed as part of the airway dead space, and therefore, the ratio of airway dead space to tidal volume increased from 0.51 ± 0.04 to 0.68 ± 0.06, from 0.43 ± 0.04 to 0.62 ± 0.01 and from 0.38 ± 0.01 to 0.60 ± 0.02 in the 2, 2.5 and 3 kg simulated neonates, respectively (p < .001). Compared to baseline ventilation, adding apparatus dead space decreased the ratio of the volume of phase III to VT size from 31% to 11% (2 kg), from 40% to 16% (2.5 kg) and from 50% to 18% (3 kg); (p < .001). CONCLUSIONS The addition of a small apparatus dead space artificially deformed the volumetric capnograms in simulated neonates with healthy lungs.
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Affiliation(s)
- Marcelo D Campos
- Department of Anesthesiology, Sanatorio Finochietto, Buenos Aires, Argentina
| | - Lucio H Palazzi
- Department of Anesthesiology, Children Hospital Dr. Orlando Alassia, Santa Fe, Argentina
| | - Stephan H Böhm
- Clinic of Anesthesiology, Intensive Care Medicine and Pain Therapy, Rostock University Medical Center, Rostock, Germany
| | - Gerardo Tusman
- Department of Anesthesia, Hospital Privado de Comunidad, Mar del Plata, Argentina
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Abstract
Capnography is now recognized as an indispensable patient safety monitor. Evidence suggests that its use improves outcomes in operating rooms, intensive care units, and emergency departments, as well as in sedation suites, in postanesthesia recovery units, and on general postsurgical wards. Capnography can accurately and rapidly detect respiratory, circulatory, and metabolic derangements. In addition to being useful for diagnosing and managing esophageal intubation, capnography provides crucial information when used for monitoring airway patency and hypoventilation in patients without instrumented airways. Despite its ubiquitous use in high-income-country operating rooms, deaths from esophageal intubations continue to occur in these contexts due to incorrect use or interpretation of capnography. National and international society guidelines on airway management mandate capnography's use during intubations across all hospital areas, and recommend it when ventilation may be impaired, such as during procedural sedation. Nevertheless, capnography's use across high-income-country intensive care units, emergency departments, and postanesthesia recovery units remains inconsistent. While capnography is universally used in high-income-country operating rooms, it remains largely unavailable to anesthesia providers in low- and middle-income countries. This lack of access to capnography likely contributes to more frequent and serious airway events and higher rates of perioperative mortality in low- and middle-income countries. New capnography equipment, which overcomes cost and context barriers, has recently been developed. Increasing access to capnography in low- and middle-income countries must occur to improve patient outcomes and expand universal health care. It is time to extend capnography's safety benefits to all patients, everywhere.
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Affiliation(s)
- Elliot A Wollner
- From the Department of Anaesthesia and Perioperative Medicine, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
- Center for Health Equity in Surgery and Anesthesia (CHESA), University of California, San Francisco, California
| | - Maziar M Nourian
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ki K Bertille
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Pauline B Wake
- School of Medicine and Health Sciences, University of Papua New Guinea
| | - Michael S Lipnick
- Department of Anesthesia and Perioperative Medicine, Center for Health Equity in Surgery and Anesthesia (CHESA), University of California, San Francisco, California
| | - David K Whitaker
- Department of Anaesthesia and Intensive Care, Manchester Royal Infirmary, United Kingdom
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Evans FM, Turc R, Echeto-Cerrato MA, Gathuya ZN, Enright A. The Capnography Project. Anesth Analg 2023; 137:922-928. [PMID: 37862390 DOI: 10.1213/ane.0000000000006663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Capnography is an essential tool used in the monitoring of patients during anesthesia and in critical care which, while required in most high-income countries, is unavailable in many low- and middle-income countries. Launched in 2020, the Smile Train-Lifebox Capnography Project aimed to find a "capnography solution" for resource-poor settings. The project was specifically interested in a capnography device that would meet the needs of the Smile Train partner hospitals to help monitor children requiring airway or cleft surgery. Project advisory and technical groups were formed and included representation from anesthesia practitioners from a balanced representation from all level of income countries, technical experts in capnography, and representatives from the Global Capnography Project (GCAP), the University of California at San Francisco Center for Health Equity in Surgery & Anesthesia (CHESA), and the World Federation of Societies of Anaesthesiologists (WFSA). Built upon the WFSA minimum capnometer specifications, a human centered design approach was used to develop a Target Product Profile. Seven manufacturers submitted 13 devices for consideration and 3 devices were selected for the testing phase. Each of these devices was evaluated for build quality, and clinical and usability performance. Based on the findings from the overall testing process, a combined capnography and pulse oximetry device by Zug Medical Systems was chosen. To accompany the new Smile Train-Lifebox capnograph, an international team of experienced anesthesiologists and educators came together to develop the necessary education materials. These materials were piloted in Ethiopia, subsequently modified, and endorsed by the education team. The device is now ready for distribution, with the accompanying education package, to the Smile Train network and beyond. In addition, a study is being planned to measure the impact of capnography introduction into operating rooms in resource-constrained settings.
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Affiliation(s)
- Faye M Evans
- From the Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Maria A Echeto-Cerrato
- Hospital del Valle, San Pedro Sula, Honduras
- Honduran National University for the Sula Valley (UNAH-VS) San Pedro Sula, Honduras
| | | | - Angela Enright
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Anesthesia, Royal Jubilee Hospital, Victoria, British Columbia, Canada
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Affiliation(s)
- Robert J McDougall
- Department of Anaesthesia and Pain Management, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Wayne W Morriss
- Department of Anaesthesia, University of Otago, Christchurch Hospital, Christchurch, New Zealand
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
| | | | - Natsagdorj Batgombo
- Department of Anesthesiology and Intensive Care, Intermed Hospital, Ulaanbaatar, Mongolia
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15
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O'Sullivan EP, Nabukenya MT, Newton M. Global Capnography to Improve Safety for All Patients: Time for Urgent Action. Anesth Analg 2023; 137:917-920. [PMID: 37862388 DOI: 10.1213/ane.0000000000006735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Affiliation(s)
- Ellen P O'Sullivan
- From the Department of Anesthesiology, Critical Care, and Pain Medicine, St James's Hospital, Dublin, Ireland
| | - Mary T Nabukenya
- Department of Anesthesiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mark Newton
- Department of Anesthesiology and Critical Care,Vanderbilt University Medical Center, Nashville, Tennessee
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16
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Doufas AG, Laporta ML, Driver CN, Di Piazza F, Scardapane M, Bergese SD, Urman RD, Khanna AK, Weingarten TN. Incidence of postoperative opioid-induced respiratory depression episodes in patients on room air or supplemental oxygen: a post-hoc analysis of the PRODIGY trial. BMC Anesthesiol 2023; 23:332. [PMID: 37794334 PMCID: PMC10548743 DOI: 10.1186/s12871-023-02291-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Supplemental oxygen (SO) potentiates opioid-induced respiratory depression (OIRD) in experiments on healthy volunteers. Our objective was to examine the relationship between SO and OIRD in patients on surgical units. METHODS This post-hoc analysis utilized a portion of the observational PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial dataset (202 patients, two trial sites), which involved blinded continuous pulse oximetry and capnography monitoring of postsurgical patients on surgical units. OIRD incidence was determined for patients receiving room air (RA), intermittent SO, or continuous SO. Generalized estimating equation (GEE) models, with a Poisson distribution, a log-link function and time of exposure as offset, were used to compare the incidence of OIRD when patients were receiving SO vs RA. RESULTS Within the analysis cohort, 74 patients were always on RA, 88 on intermittent and 40 on continuous SO. Compared with when on RA, when receiving SO patients had a higher risk for all OIRD episodes (incidence rate ratio [IRR] 2.7, 95% confidence interval [CI] 1.4-5.1), apnea episodes (IRR 2.8, 95% CI 1.5-5.2), and bradypnea episodes (IRR 3.0, 95% CI 1.2-7.9). Patients with high or intermediate PRODIGY scores had higher IRRs of OIRD episodes when receiving SO, compared with RA (IRR 4.5, 95% CI 2.2-9.6 and IRR 2.3, 95% CI 1.1-4.9, for high and intermediate scores, respectively). CONCLUSIONS Despite oxygen desaturation events not differing between SO and RA, SO may clinically promote OIRD. Clinicians should be aware that postoperative patients receiving SO therapy remain at increased risk for apnea and bradypnea. TRIAL REGISTRATION Clinicaltrials.gov: NCT02811302, registered June 23, 2016.
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Affiliation(s)
- Anthony G Doufas
- Department of Anesthesiology, Perioperative and Pain Medicine, Center for Sleep and Circadian Sciences, Stanford University School of Medicine, 300 Pasteur Drive, H3580, Stanford, San Francisco, CA, 94305-5640, USA.
| | - Mariana L Laporta
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - C Noelle Driver
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Fabio Di Piazza
- Medtronic Core Clinical Solutions, Global Clinical Data Solutions, Rome, Italy
| | - Marco Scardapane
- Medtronic Core Clinical Solutions, Global Clinical Data Solutions, Rome, Italy
| | - Sergio D Bergese
- Department of Anesthesiology and Neurological Surgery, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Richard D Urman
- Department of Anesthesiology, The Ohio State University and Wexner Medical Center, Columbus, OH, USA
| | - Ashish K Khanna
- Section On Critical Care Medicine, Department of Anesthesiology, Wake Forest Center for Biomedical Informatics, Perioperative Outcomes and Informatics Collaborative (POIC), Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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17
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Morgan TJ, Scott PH, Langley AN, Barrett RDC, Anstey CM. Single-FiO 2 lung modelling with machine learning: a computer simulation incorporating volumetric capnography. J Clin Monit Comput 2023; 37:1303-1311. [PMID: 37004663 PMCID: PMC10066977 DOI: 10.1007/s10877-023-00996-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/14/2023] [Indexed: 04/04/2023]
Abstract
We investigated whether machine learning (ML) analysis of ICU monitoring data incorporating volumetric capnography measurements of mean alveolar PCO2 can partition venous admixture (VenAd) into its shunt and low V/Q components without manipulating the inspired oxygen fraction (FiO2). From a 21-compartment ventilation / perfusion (V/Q) model of pulmonary blood flow we generated blood gas and mean alveolar PCO2 data in simulated scenarios with shunt values from 7.3% to 36.5% and a range of FiO2 settings, indirect calorimetry and cardiac output measurements and acid- base and hemoglobin oxygen affinity conditions. A 'deep learning' ML application, trained and validated solely on single FiO2 bedside monitoring data from 14,736 scenarios, then recovered shunt values in 500 test scenarios with true shunt values 'held back'. ML shunt estimates versus true values (n = 500) produced a linear regression model with slope = 0.987, intercept = -0.001 and R2 = 0.999. Kernel density estimate and error plots confirmed close agreement. With corresponding VenAd values calculated from the same bedside data, low V/Q flow can be reported as VenAd-shunt. ML analysis of blood gas, indirect calorimetry, volumetric capnography and cardiac output measurements can quantify pulmonary oxygenation deficits as percentage shunt flow (V/Q = 0) versus percentage low V/Q flow (V/Q > 0). High fidelity reports are possible from analysis of data collected solely at the operating FiO2.
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Affiliation(s)
- Thomas J Morgan
- Mater Research and University of Queensland, Stanley Street, South Brisbane, Brisbane, QLD, 4101, Australia.
| | - Peter H Scott
- Intensive Care Department, Mater Health Services, Stanley Street, South Brisbane, Brisbane, QLD, 4101, Australia
- University of Queensland, Brisbane, QLD, 4072, Australia
| | - Adrian N Langley
- Intensive Care Department, Mater Health Services, Stanley Street, South Brisbane, Brisbane, QLD, 4101, Australia
- University of Queensland, Brisbane, QLD, 4072, Australia
| | | | - Christopher M Anstey
- University of Queensland, Brisbane, QLD, 4072, Australia
- Griffith University, Gold Coast, QLD, 4215, Australia
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18
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Conway A, Goudarzi Rad M, Zhou W, Parotto M, Jungquist C. Deep learning classification of capnography waveforms: secondary analysis of the PRODIGY study. J Clin Monit Comput 2023; 37:1327-1339. [PMID: 37178234 DOI: 10.1007/s10877-023-01028-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
Capnography monitors trigger high priority 'no breath' alarms when CO2 measurements do not exceed a given threshold over a specified time-period. False alarms occur when the underlying breathing pattern is stable, but the alarm is triggered when the CO2 value reduces even slightly below the threshold. True 'no breath' events can be falsely classified as breathing if waveform artifact causes an aberrant spike in CO2 values above the threshold. The aim of this study was to determine the accuracy of a deep learning approach to classifying segments of capnography waveforms as either 'breath' or 'no breath'. A post hoc secondary analysis of data from 9 North American sites included in the PRediction of Opioid-induced Respiratory Depression In Patients Monitored by capnoGraphY (PRODIGY) study was conducted. We used a convolutional neural network to classify 15 s capnography waveform segments drawn from a random sample of 400 participants. Loss was calculated over batches of 32 using the binary cross-entropy loss function with weights updated using the Adam optimizer. Internal-external validation was performed by iteratively fitting the model using data from all but one hospital and then assessing its performance in the remaining hospital. The labelled dataset consisted of 10,391 capnography waveform segments. The neural network's accuracy was 0.97, precision was 0.97 and recall was 0.96. Performance was consistent across hospitals in internal-external validation. The neural network could reduce false capnography alarms. Further research is needed to compare the frequency of alarms derived from the neural network with the standard approach.
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Affiliation(s)
- Aaron Conway
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
| | | | - Wentao Zhou
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Matteo Parotto
- Department of Anesthesia and Pain Management, Toronto General Hospital, UHN, Toronto, Canada
- Department of Anesthesiology and Pain Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
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19
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Almudares F, Fernandes CJ. Early quantitative capnography to enhance neonatal resuscitation in extremely premature infants. Acta Paediatr 2023; 112:2010-2011. [PMID: 37170649 DOI: 10.1111/apa.16838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/10/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Faeq Almudares
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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20
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Olicker AL, Martin RJ, Deakins K. Is capnography on neonatal transport the answer? Acta Paediatr 2023; 112:1842-1843. [PMID: 37312261 DOI: 10.1111/apa.16854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/22/2023] [Indexed: 06/15/2023]
Affiliation(s)
- Arielle L Olicker
- Division of Neonatology, Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Richard J Martin
- Division of Neonatology, Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Kathleen Deakins
- Pediatric Respiratory Care Department, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
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21
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Murray EK, You CX, Verghese GC, Krauss BS, Heldt T. Low-Order Mechanistic Models for Volumetric and Temporal Capnography: Development, Validation, and Application. IEEE Trans Biomed Eng 2023; 70:2710-2721. [PMID: 37030832 DOI: 10.1109/tbme.2023.3262764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Develop low-order mechanistic models accounting quantitatively for, and identifiable from, the capnogram - the CO 2 concentration in exhaled breath, recorded over time (Tcap) or exhaled volume (Vcap). METHODS The airflow model's single "alveolar" compartment has compliance and inertance, and feeds a resistive unperfused airway comprising a laminar-flow region followed by a turbulent-mixing region. The gas-mixing model tracks mixing-region CO 2 concentration, fitted breath-by-breath to the measured capnogram, yielding estimates of model parameters that characterize the capnogram. RESULTS For the 17 examined records (310 breaths) of airflow, airway pressure and Tcap from ventilated adult patients, the models fit closely (mean rmse 1% of end-tidal CO 2 concentration on Vcap; 1.7% on Tcap). The associated parameters (4 for Vcap, 5 for Tcap) for each exhalation, and airflow parameters for the corresponding forced inhalation, are robustly estimated, and consonant with literature values. The models also allow, using Tcap alone, estimation of the entire exhaled airflow waveform to within a scaling. This suggests new Tcap-based tests, analogous to spirometry but with normal breathing, for discriminating chronic obstructive pulmonary disease (COPD) from congestive heart failure (CHF). A version trained on 15 exhalations from each of 24 COPD/24 CHF Tcap records from one hospital, then tested 100 times with 15 random exhalations from each of 27 COPD/31 CHF Tcap records at another, gave mean accuracy 80.6% (stdev 2.1%). Another version, tested on 29 COPD/32 CHF, yielded AUROC 0.84. CONCLUSION Our mechanistic models closely fit Tcap and Vcap measurements, and yield subject-specific parameter estimates. SIGNIFICANCE This can inform cardiorespiratory care.
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Nijbroek SGLH, Roozeman JP, Ettayeby S, Rosenberg NM, van Meenen DMP, Cherpanath TGV, Lagrand WK, Tepaske R, Klautz RJM, Serpa Neto A, Schultz MJ. Closed-Loop ventilation using sidestream versus mainstream capnography for automated adjustments of minute ventilation-A randomized clinical trial in cardiac surgery patients. PLoS One 2023; 18:e0289412. [PMID: 37611007 PMCID: PMC10446221 DOI: 10.1371/journal.pone.0289412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND INTELLiVENT-Adaptive Support Ventilation (ASV) is a closed-loop ventilation mode that uses capnography to adjust tidal volume (VT) and respiratory rate according to a user-set end-tidal CO2 (etCO2) target range. We compared sidestream versus mainstream capnography with this ventilation mode with respect to the quality of breathing in patients after cardiac surgery. METHODS Single-center, single-blinded, non-inferiority, randomized clinical trial in adult patients scheduled for elective cardiac surgery that were expected to receive at least two hours of postoperative ventilation in the ICU. Patients were randomized 1:1 to closed-loop ventilation with sidestream or mainstream capnography. Each breath was classified into a zone based on the measured VT, maximum airway pressure, etCO2 and pulse oximetry. The primary outcome was the proportion of breaths spent in a predefined 'optimal' zone of ventilation during the first three hours of postoperative ventilation, with a non-inferiority margin for the difference in the proportions set at -20%. Secondary endpoints included the proportion of breaths in predefined 'acceptable' and 'critical' zones of ventilation, and the proportion of breaths with hypoxemia. RESULTS Of 80 randomized subjects, 78 were included in the intention-to-treat analysis. We could not confirm the non-inferiority of closed-loop ventilation using sidestream with respect to the proportion of breaths in the 'optimal' zone (mean ratio 0.87 [0.77 to ∞]; P = 0.116 for non-inferiority). The proportion of breaths with hypoxemia was higher in the sidestream capnography group versus the mainstream capnography group. CONCLUSIONS We could not confirm that INTELLiVENT-ASV using sidestream capnography is non-inferior to INTELLiVENT-ASV using mainstream capnography with respect to the quality of breathing in subjects receiving postoperative ventilation after cardiac surgery. TRIAL REGISTRATION NCT04599491 (clinicaltrials.gov).
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Affiliation(s)
- Sunny G. L. H. Nijbroek
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Jan-Paul Roozeman
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Sarah Ettayeby
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Neeltje M. Rosenberg
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Department of Internal Medicine, Spaarne Hospital, Haarlem, The Netherlands
| | - David M. P. van Meenen
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Thomas G. V. Cherpanath
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Wim K. Lagrand
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Robert Tepaske
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Robert J. M. Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ary Serpa Neto
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Australian and New Zealand Intensive Care Research Centre (ANZIC–RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Department of Critical Care, Austin Hospital, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paolo, Brazil
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
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Hansel J, Law JA, Chrimes N, Higgs A, Cook TM. Clinical tests for confirming tracheal intubation or excluding oesophageal intubation: a diagnostic test accuracy systematic review and meta-analysis. Anaesthesia 2023; 78:1020-1030. [PMID: 37325847 DOI: 10.1111/anae.16059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/17/2023]
Abstract
Unrecognised oesophageal intubation causes preventable serious harm to patients undergoing tracheal intubation. When capnography is unavailable or doubted, clinicians still use clinical findings to confirm tracheal intubation, or exclude oesophageal intubation, and false reassurance from clinical examination is a recurring theme in fatal cases of unrecognised oesophageal intubation. We conducted a systematic review and meta-analysis of the diagnostic accuracy of five clinical examination tests and the oesophageal detector device when used to confirm tracheal intubation. We searched four databases for studies reporting index clinical tests against a reference standard, from inception to 28 February 2023. We included 49 studies involving 10,654 participants. Methodological quality was overall moderate to high. We looked at misting (three studies, 115 participants); lung auscultation (three studies, 217 participants); combined lung and epigastric auscultation (four studies, 506 participants); the oesophageal detector device (25 studies, 3024 participants); 'hang-up' (two non-human studies); and chest rise (one non-human study). The reference standards used were capnography (22 studies); direct vision (10 studies); and bronchoscopy (three studies). When used to confirm tracheal intubation, misting has a false positive rate (95%CI) of 0.69 (0.43-0.87); lung auscultation 0.14 (0.08-0.23); five-point auscultation 0.18 (0.08-0.36); and the oesophageal detector device 0.05 (0.02-0.09). Tests to exclude events that invariably lead to severe damage or death must have a negligible false positive rate. Misting or auscultation have too high a false positive rate to reliably exclude oesophageal intubation and there is insufficient evidence to support the use of 'hang-up' or chest rise. The oesophageal detector device may be considered where other more reliable means are not available, though waveform capnography remains the reference standard for confirmation of tracheal intubation.
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Affiliation(s)
- J Hansel
- Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester, Manchester, UK
| | - J A Law
- Department of Anesthesia, Pain Management and Perio-perative Medicine, Dalhousie University, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - N Chrimes
- Department of Anaesthesia, Monash Medical Centre, Melbourne, VIC, Australia
| | - A Higgs
- Department of Anaesthesia and Intensive Care, Warrington Teaching Hospitals NHS Foundation Trust, Cheshire, UK
| | - T M Cook
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- School of Medicine, University of Bristol, Bristol, UK
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24
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Qureshi T, Hutton P, Pandit JJ. Sharpening PUMA's teeth: improving guidance for capnography to confirm tracheal intubation in cardiopulmonary resuscitation. Anaesthesia 2023; 78:937-942. [PMID: 36947864 DOI: 10.1111/anae.16002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/24/2023]
Affiliation(s)
- T Qureshi
- Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - P Hutton
- University of Birmingham, UK
- Guy's and St Thomas' NHS Foundation Trust (Heart, Lung and Critical Care Clinical Group), London, UK
| | - J J Pandit
- Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- University of Oxford, UK
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25
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de la Mata Navazo S, Manrique G, Fernández SN, Pérez G, Butragueño-Laiseca L, García M, Slöcker M, González R, Herrera L, Mencía S, Del Castillo J, Solana MJ, Sanz D, Cieza R, López J, Rodríguez Martínez A, Santiago MJ, Urbano J, López-Herce J. Volumetric capnography and return of spontaneous circulation in an experimental model of pediatric asphyxial cardiac arrest. Sci Rep 2023; 13:12247. [PMID: 37507472 PMCID: PMC10382559 DOI: 10.1038/s41598-023-37827-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
A secondary analysis of a randomized study was performed to study the relationship between volumetric capnography (VCAP) and arterial CO2 partial pressure (PCO2) during cardiopulmonary resuscitation (CPR) and to analyze the ability of these parameters to predict the return of spontaneous circulation (ROSC) in a pediatric animal model of asphyxial cardiac arrest (CA). Asphyxial CA was induced by sedation, muscle relaxation and extubation. CPR was started 2 min after CA occurred. Airway management was performed with early endotracheal intubation or bag-mask ventilation, according to randomization group. CPR was continued until ROSC or 24 min of resuscitation. End-tidal carbon dioxide (EtCO2), CO2 production (VCO2), and EtCO2/VCO2/kg ratio were continuously recorded. Seventy-nine piglets were included, 26 (32.9%) of whom achieved ROSC. EtCO2 was the best predictor of ROSC (AUC 0.72, p < 0.01 and optimal cutoff point of 21.6 mmHg). No statistical differences were obtained regarding VCO2, VCO2/kg and EtCO2/VCO2/kg ratios. VCO2 and VCO2/kg showed an inverse correlation with PCO2, with a higher correlation coefficient as resuscitation progressed. EtCO2 also had an inverse correlation with PCO2 from minute 18 to 24 of resuscitation. Our findings suggest that EtCO2 is the best VCAP-derived parameter for predicting ROSC. EtCO2 and VCO2 showed an inverse correlation with PCO2. Therefore, these parameters are not adequate to measure ventilation during CPR.
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Affiliation(s)
- Sara de la Mata Navazo
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Gema Manrique
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain.
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain.
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain.
| | - Sarah Nicole Fernández
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Gema Pérez
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Laura Butragueño-Laiseca
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Miriam García
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - María Slöcker
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Rafael González
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
- Maternal and Child Public Health Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Laura Herrera
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Santiago Mencía
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
- Maternal and Child Public Health Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Jimena Del Castillo
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - María José Solana
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
- Maternal and Child Public Health Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Débora Sanz
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Raquel Cieza
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Jorge López
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Alicia Rodríguez Martínez
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - María José Santiago
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
- Maternal and Child Public Health Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Javier Urbano
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Jesús López-Herce
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
- Maternal and Child Public Health Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
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Abstract
INTRODUCTION End-tidal carbon dioxide (ETCO2) monitoring is essential for monitoring intubated critical care patients, yet its use in hyperbaric environments can be problematic. We postulated that the EMMA mainstream capnometer may function accurately under hyperbaric conditions. METHODS Stage 1. The EMMA mainstream capnometer was tested at 101 kPa against a reference side-stream capnometer, Philips IntelliVue M3015B microstream, using 10 customised reference gases of various carbon dioxide (CO₂) concentrations (2.47%-8.09%, or 18.5-60.7 mmHg at 101 kPa) in either air or oxygen. Stage 2. The functionality and accuracy of the EMMA capnometer was tested under hyperbaric conditions, 121-281 kPa, using the same test gases. RESULTS At 101 kPa, the EMMA capnometer measured CO₂ at levels lower than expected (mean of differences = -2.5 mmHg (95% CI -2.1 to -2.9, P < 0.001)). The Philips capnometer measured CO₂ more closely to expected CO₂ (mean of differences = -1.1 mmHg (95% CI -0.69 to -1.4, P < 0.001). Both devices demonstrated a significant linear relationship with expected CO₂. The EMMA capnometer functioned up to the maximum test pressure (281 kPa). The device over-read CO₂ measurements at pressures > 141 kPa. Although variance increased at pressures in the therapeutic range for hyperbaric treatments, a significant linear relationship between expected and EMMA measured CO₂ was demonstrated. The EMMA capnometer tolerated pressures to 281 kPa, but its display was limited to CO₂ < 99 mmHg. CONCLUSIONS This study validated EMMA capnometer function to 281 kPa in the hyperbaric environment. The device over-read CO₂ measurements at pressures >141 kPa, however there was a linear relationship between expected and measured CO₂. The EMMA capnometer may be clinically useful for monitoring expired CO₂ in patients undergoing hyperbaric oxygen treatment.
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Affiliation(s)
- Alicia Tucker
- Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
- Corresponding author: Dr Alicia Tucker, Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, 26 Campbell St, Hobart 7000, Tasmania, Australia,
| | - David Smart
- Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
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Champreeda V, Hu R, Chan B, Tomasek O, Lin YH, Weinberg L, Howard W, Tan CO. Nocturnal respiratory abnormalities among ward-level postoperative patients as detected by the Capnostream 20p monitor: A blinded observational study. PLoS One 2023; 18:e0280436. [PMID: 36662703 PMCID: PMC9858304 DOI: 10.1371/journal.pone.0280436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/01/2023] [Indexed: 01/21/2023] Open
Abstract
PURPOSE This prospective observational study aimed to establish the frequency of postoperative nocturnal respiratory abnormalities among patients undergoing major surgery who received ward-level care. These abnormalities may have implications for postoperative pulmonary complications (PPCs). METHODS Eligible patients underwent blinded noninvasive continuous capnography with pulse oximetry using the Capnostream™ 20p monitor over the first postoperative night. All patients received oxygen supplementation and patient-controlled opioid analgesia. The primary outcome was the number of prolonged apnea events (PAEs), defined as end-tidal carbon dioxide (EtCO2) ≤5 mmHg for 30-120 seconds or EtCO2 ≤5 mmHg for >120 seconds with oxygen saturation (SpO2) <85%. Secondary outcomes were the proportion of recorded time that physiological indices were aberrant, including the apnea index (AI), oxygen desaturation index (ODI), integrated pulmonary index (IPI), and SpO2. Exploratory analysis was conducted to assess the associations between PAEs, PPCs, and pre-defined factors. RESULTS Among 125 patients who had sufficient data for analysis, a total of 1800 PAEs occurred in 67 (53.4%) patients. The highest quartile accounted for 89.1% of all events. Amongst patients who experienced any PAEs, the median (IQR) number of PAE/patient was four (2-12). As proportions of recorded time (median (IQR)), AI, ODI, and IPI were aberrant for 12.4% (0-43.2%), 19.1% (2.0-57.1%), and 11.5% (3.1-33.3%) respectively. Only age, ARISCAT, and opioid consumption/kg were associated with PPCs. CONCLUSIONS PAE and aberrant indices were frequently detected on the first postoperative night. However, they did not correlate with PPCs. Future research should investigate the significance of detected aberrations.
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Affiliation(s)
- Vichaya Champreeda
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Raymond Hu
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Brandon Chan
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Owen Tomasek
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Yuan-Hong Lin
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Laurence Weinberg
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Will Howard
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Chong O. Tan
- Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
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Kor JJ, Sprung J, Khanna AK, Weingarten TN. Continuous Monitoring Detected Respiratory Depressive Episodes in Proximity to Adverse Respiratory Events During the PRODIGY Trial. J Patient Saf 2022; 18:738-741. [PMID: 35405725 PMCID: PMC9698081 DOI: 10.1097/pts.0000000000001003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE The PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial was a multicenter prospective trial conducted to develop a risk prediction score for opioid-induced respiratory depressive (OIRD) episodes. Several subjects in the PRODIGY trial developed critical respiratory depressive events, which were qualified as reportable adverse events (AEs). In this study, we determine whether those patients also had an episode of OIRD as detected by continuous capnography and pulse oximetry leading up to the critical clinical event. METHODS Blinded capnography and pulse oximetry data from PRODIGY patients who had critical respiratory depressive AE were reviewed. The occurrence and timing of OIRD episodes were recorded in relationship to the AE. RESULTS Of the 1335 subjects in PRODIGY, 7 patients had 8 reportable pulmonary AE and 187 OIRDs (150 apnea episodes, 14 bradypnea episodes, 23 hypoxic episodes) with median 12 (5-19.5) OIRDs per patient. Five patients were monitored before the AE, and multiple preceding OIRD episodes were detected. One patient had 2 AE, the first (hypoxemia) was recognized upon application of pulse oximetry. This patient subsequently had multiple OIRDs until the second AE occurred (somnolence requiring naloxone administration). Another patient's AE (hypotension and bradypnea) was recognized upon monitor application and subsequently had many OIRD episodes. CONCLUSIONS In the PRODIGY trial, patients who had a pulmonary AE had multiple preceding OIRDs detected by continuous capnography and pulse oximetry. When monitoring was initiated before the AE, numerous OIRDs, mostly apneic episodes preceded AE, suggesting continuous monitoring of both ventilation and oxygenation may allow for early detection and possible prediction of future clinical decompensation.
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Affiliation(s)
- Jennifer J. Kor
- From the Kentucky College of Osteopathic Medicine, Pikeville, Kentucky
| | - Juraj Sprung
- Departments of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Ashish K. Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Outcomes Research Consortium, Cleveland, Ohio
| | - Toby N. Weingarten
- Departments of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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Olsen F, Suyderhoud JP, Khanna AK. Respiratory monitoring of nonintubated patients in nonoperating room settings: old and new technologies. Curr Opin Anaesthesiol 2022; 35:521-527. [PMID: 35788554 DOI: 10.1097/aco.0000000000001129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Postoperative mortality in the 30 days after surgery remains disturbingly high. Inadequate, intermittent and incomplete monitoring of vital signs in the nonoperating room environment is common practice. The rise of nonoperating room anaesthesia and sedation outside the operating room has highlighted the need to develop new and robust methods of portable continuous respiratory monitoring. This review provides a summary of old and new technologies in this environment. RECENT FINDINGS Technical advances have made possible the utilization of established monitoring to extrapolate respiratory rate, the increased availability and user friendliness of side stream capnography and the advent of other innovative systems. The use of aggregate signals wherein different modalities compensate for individual shortcomings seem to provide a reliable and artefact-free system. SUMMARY Respiratory monitoring is required in several situations and patient categories outside the operating room. The chosen modality must be able to detect respiratory compromise in a timely and accurate manner. Combing several modalities in a nonobtrusive, nontethered system and having an integrated output seems to give a reliable and responsive signal.
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Affiliation(s)
- Fredrik Olsen
- Department of Anesthesiology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
- Department of Anaesthesiology and Critical Care, Sahlgrenska University Hospital/Mölndal, Sweden
| | - Johan Pieter Suyderhoud
- Department of Anesthesiology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
- Outcomes Research Consortium, Cleveland, Ohio, USA
- Perioperative Outcomes and Informatics Collaborative, Winston-Salem, North Carolina, USA
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Camargo MG, Moreira MM, Magro DO, Santos JOM, Ayrizono MDLS. VOLUMETRIC CAPNOGRAPHY FOR RESPIRATORY MONITORING OF PATIENTS DURING ROUTINE COLONOSCOPY WITH ROOM-AIR AND CARBON DIOXIDE INSUFFLATION. Arq Gastroenterol 2022; 59:383-389. [PMID: 36102436 DOI: 10.1590/s0004-2803.202203000-69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Capnography and carbon dioxide (CO2) insufflation during gastrointestinal endoscopy under sedation are associated with safety and comfort improvements, respectively. Capnography can provide early detection of apnea and hypoxemia, whereas CO2 insufflation causes lower periprocedural discomfort. This is the first study to report the application of volumetric capnography in colonoscopy. OBJECTIVE This study aimed to evaluate the use of volumetric capnography with room air (RA) and CO2 insufflation during routine colonoscopy. METHODS In this prospective cohort study, 101 patients who underwent routine colonoscopy under sedation with volumetric capnography monitoring were included. Insufflation with RA was used to distend the intestinal lumen in group 1 (n=51), while group 2 (n=50) used CO2 insufflation. The primary endpoints were episodes of hypoxia, alveolar hypoventilation, and end-tidal CO2 (EtCO2). The secondary endpoints were tidal volume per minute, consumption of sedation medications, and post-procedure pain using the Gloucester modified pain scale. RESULTS The number of episodes of hypoxia (SpO2<90%) was similar between the groups: four episodes in Group 1 and two episodes in Group 2. The duration of hypoxia was significantly longer in group 2 (P=0.02). Hypoalveolar ventilation (EtCO2) occurred more frequently in Group 2 than in Group 1 (27 vs 18 episodes, P=0.05). Regarding EtCO2, Group 2 showed higher values in cecal evaluation (28.94±4.68 mmHg vs 26.65±6.12 mmHg, P=0.04). Regarding tidal volume per minute, Group 2 had significantly lower values at the cecal interval compared to Group 1 (2027.53±2818.89 vs 970.88±1840.25 L/min, P=0.009). No episodes of hypercapnia (EtCO2 > 60 mmHg) occurred during the study. There was no difference in the consumption of sedation medications between the groups. Immediately after colonoscopy, Group 2 reported significantly less pain than Group 1 (P=0.05). CONCLUSION In our study, volumetric capnography during colonoscopy was feasible and effective for monitoring ventilatory parameters and detecting respiratory complications. CO2 insufflation was safe and associated with less pain immediately after colonoscopy.
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Affiliation(s)
- Michel Gardere Camargo
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Gastrocentro, Campinas, SP, Brasil
| | - Marcos Mello Moreira
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Clínica Médica, Disciplina de Pneumologia, Campinas, SP, Brasil
| | - Daniéla Oliveira Magro
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Gastrocentro, Campinas, SP, Brasil
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Ahmed S, Islam MT, Biswas S, Samrat RH, Akash TI, Subhana A, Shahnaz C. CapNet: A Deep Learning-based Framework for Estimation of Capnograph Signal from PPG. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:3392-3395. [PMID: 36086237 DOI: 10.1109/embc48229.2022.9871828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Ambulatory respiration signal extraction system is required to maintain continuous surveillance of a patient with respiratory deficiency. The capnograph signal has received a lot of attention in recent years as a valuable indicator of respiratory conditions. However, the typical capnograph signal extraction method is quite expensive and also unpleasant to the patient due to the involvement of a nasal cannula. With the advent of wearable sensor technology, there has been significant research on the use of photoplethysmogram (PPG) signals as a less expensive alternative to extract respiratory information. In this paper, we propose CapNet, a novel deep learning-based framework which takes the regular PPG signal as input, and estimates the capnograph signal as output. Training, validation and testing of the proposed networks in CapNet is done using the IEEE TMBE Respiratory Rate Benchmark dataset by utilizing reference capnograph respiration signals. With a lower MSE and higher cross-correlation values, CapNet outperforms two traditional signal processing algorithms and another recently proposed deep neural network, RespNet. The proposed framework expectantly can be implementable and feasible for constant supervising of patients undergoing respiratory ailments.
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Zhang L, Jin K, Sun F, Xu J, Yu X, Zhu H, Fu Y, Liu D, Yu S. Assessment of a new volumetric capnography-derived parameter to reflect compression quality and to predict return of spontaneous circulation during cardiopulmonary resuscitation in a porcine model. J Clin Monit Comput 2022; 36:199-207. [PMID: 33511562 DOI: 10.1007/s10877-020-00637-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 12/17/2020] [Indexed: 11/25/2022]
Abstract
We aimed to evaluate a volumetric capnography (Vcap)-derived parameter, the volume of CO2 eliminated per minute and per kg body weight (VCO2/kg), as an indicator of the quality of chest compression (CC) and to predict the return to spontaneous circulation (ROSC) under stable ventilation status. Twelve male domestic pigs were utilized for the randomized crossover study. After 4 min of untreated ventricular fibrillation (VF), mechanical cardiopulmonary resuscitation and ventilation were administered. Following 5-min washout periods, each animal underwent two sessions of experiments: three types of CC quality for 5 min stages in the first session, followed by advanced life support, consecutively in two sessions. Different CC quality had a significant effect on the partial pressure of end-tidal carbon dioxide (PetCO2), VCO2/kg, aortic pressure (mean), aortic systolic pressure, aortic diastolic pressure, right atrial pressure (mean), and carotid blood flow (P < 0.05). With the improvement in CC quality, the values of PetCO2 and VCO2/kg also increased, and the difference between the groups was statistically significant (P < 0.05). The Spearman rank test revealed a significant correlation between the Vcap-derived parameters and hemodynamics. PetCO2 and VCO2/kg have similar capabilities for discriminating survivors from non-survivors, and the area under the curve for both was 0.97. VCO2/kg had similar performance as PetCO2 in reflecting the quality of CC and prediction of achieving ROSC under stable ventilation status in a porcine model of VF-related cardiac arrest. However, VCO2/kg requires a longer time to achieve a stable state after adjusting for quality of CC than PetCO2.
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Affiliation(s)
- Lili Zhang
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Kui Jin
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Feng Sun
- Emergency Department, Jiangsu Province Hospital, Nanjing, Jiangsu, China
| | - Jun Xu
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
| | - Xuezhong Yu
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
| | - Huadong Zhu
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Yangyang Fu
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Danyu Liu
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Shanshan Yu
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
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Abstract
OBJECTIVES Capnography has established benefit during intubation and cardiopulmonary resuscitation (CPR). Implementation within emergency departments (EDs) has lagged. We sought to address barriers to improve documented capnography use for patients requiring intubation or CPR. METHODS A controlled before- and after-implementation study was performed in 2 urban EDs. The control site had an existing policy for capnography use. Interventions for the experimental site included a 5-minute informational video, placement of capnography monitors with a shortened warm-up period in all resuscitation rooms, laminated reminder cards, and feedback during staff meetings. Staff members were surveyed about knowledge before and after the intervention. Records were reviewed for documented capnography use for 3 months before and 6 months after the intervention. Change in documented use at the experimental site was compared with the control site. RESULTS At the experimental site, 118 providers participated and 190 records were reviewed; 544 records were reviewed from the control site. There was a significant increase in the proportion of documented capnography use at the experimental site (8% versus 19%, P = 0.04) compared with the control site (64% versus 71%, P = 0.10). However, there was no significant trend over time at the experimental site after the intervention (P = 0.86). Despite high baseline knowledge about capnography, providers had improvements in survey responses regarding indications for intubation and CPR, normal values, and minimum effective values during CPR. CONCLUSIONS Documented capnography use increased with simple interventions but with no positive trend. Additional work is needed to improve use, including further evaluation of capnography's implementation in the ED.
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Affiliation(s)
- Rahul Shah
- From the Department of Pediatrics, Yale University School of Medicine
| | | | - Marc Auerbach
- Section of Pediatric Emergency Medicine, Department of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Melissa L. Langhan
- Section of Pediatric Emergency Medicine, Department of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
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Kozub E, Uttermark A, Skoog R, Dickey W. Preventing Postoperative Opioid-Induced Respiratory Depression Through Implementation of an Enhanced Monitoring Program. J Healthc Qual 2022; 44:e7-e14. [PMID: 34469926 DOI: 10.1097/jhq.0000000000000322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Opioid-induced respiratory depression (OIRD) is a serious complication that can lead to negative outcomes. There are known risk factors for OIRD; however, a lack of national guidelines for the prevention and early detection of OIRD exists. METHODS An evidence-based practice study was conducted to create an enhanced monitoring (EM) program. The EM program consisted of risk stratification of surgical spine patients, including the use of STOP-BANG screening for obstructive sleep apnea, capnography monitoring, use of home positive airway pressure therapy, capnography alarm optimization, hospitalist consultation, nursing education, and patient education. RESULTS Approximately 17% (N = 937/5,462) of surgical spine patients were enrolled in the EM program. Fifty-six percent of EM patients were monitored with capnography and had out of range end-tidal carbon dioxide levels 17% of the time. The rate of transfers to the intensive care unit (ICU) for OIRD decreased, though not statistically significant (p = .151). CONCLUSIONS The EM program with risk stratification was found to reduce transfers to the ICU for OIRD. Although not statistically significant, the decreased number of transfers was clinically significant. Engagement of the interprofessional team and capnography alarm parameter optimization helped to reduce nonactionable alarms.
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Abstract
BACKGROUND Dead space is the volume not taking part in gas exchange and, if increased, could affect alveolar ventilation if there is too low a delivered volume. We determined if there were differences in dead space and alveolar ventilation in ventilated infants with pulmonary disease or no respiratory morbidity. METHODS A prospective study of mechanically ventilated infants was undertaken. Expiratory tidal volume and carbon dioxide levels were measured. Volumetric capnograms were constructed to calculate the dead space using the modified Bohr-Enghoff equation. Alveolar ventilation (VA) was also calculated. RESULTS Eighty-one infants with a median (range) gestational age of 28.7 (22.4-41.9) weeks were recruited. The dead space [median (IQR)] was higher in 35 infants with respiratory distress syndrome (RDS) [5.7 (5.1-7.0) ml/kg] and in 26 infants with bronchopulmonary dysplasia (BPD) [6.4 (5.1-7.5) ml/kg] than in 20 term controls with no respiratory disease [3.5 (2.8-4.2) ml/kg, p < 0.001]. Minute ventilation was higher in both infants with RDS or BPD compared to the controls. VA in infants with RDS or BPD was similar to that of the controls [p = 0.54]. CONCLUSION Prematurely born infants with pulmonary disease have a higher dead space than term controls, which may influence the optimum level during volume-targeted ventilation. IMPACT Measurement of the dead space was feasible in ventilated newborn infants. The physiological dead space was a significant proportion of the delivered volume in ventilated infants. The dead space (per kilogram) was higher in ventilated infants with respiratory distress syndrome or evolving bronchopulmonary dysplasia compared to term controls without respiratory disease. The dead space volume should be considered when calculating the most appropriate volume during volume-targeted ventilation.
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Affiliation(s)
- Emma Williams
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK
| | - Theodore Dassios
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
- Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK.
- NIHR Biomedical Centre at Guy's and St Thomas NHS Foundation Trust, King's College London, London, UK.
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Hirabayashi G, Yokose Y, Nagata K, Oshika H, Saito M, Akihisa Y, Maruyama K, Andoh T. Changes in dead space components during pressure-controlled inverse ratio ventilation: A secondary analysis of a randomized trial. PLoS One 2021; 16:e0258504. [PMID: 34644352 PMCID: PMC8513857 DOI: 10.1371/journal.pone.0258504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 09/15/2021] [Indexed: 11/22/2022] Open
Abstract
Background We previously reported that there were no differences between the lung-protective actions of pressure-controlled inverse ratio ventilation and volume control ventilation based on the changes in serum cytokine levels. Dead space represents a ventilation-perfusion mismatch, and can enable us to understand the heterogeneity and elapsed time changes in ventilation-perfusion mismatch. Methods This study was a secondary analysis of a randomized controlled trial of patients who underwent robot-assisted laparoscopic radical prostatectomy. The inspiratory to expiratory ratio was adjusted individually by observing the expiratory flow-time wave in the pressure-controlled inverse ratio ventilation group (n = 14) and was set to 1:2 in the volume-control ventilation group (n = 13). Using volumetric capnography, the physiological dead space was divided into three dead space components: airway, alveolar, and shunt dead space. The influence of pressure-controlled inverse ratio ventilation and time factor on the changes in each dead space component rate was analyzed using the Mann-Whitney U test and Wilcoxon’s signed rank test. Results The physiological dead space and shunt dead space rate were decreased in the pressure-controlled inverse ratio ventilation group compared with those in the volume control ventilation group (p < 0.001 and p = 0.003, respectively), and both dead space rates increased with time in both groups. The airway dead space rate increased with time, but the difference between the groups was not significant. There were no significant changes in the alveolar dead space rate. Conclusions Pressure-controlled inverse ratio ventilation reduced the physiological dead space rate, suggesting an improvement in the total ventilation/perfusion mismatch due to improved inflation of the alveoli affected by heterogeneous expansion disorder without hyperinflation of the normal alveoli. However, the shunt dead space rate increased with time, suggesting that atelectasis developed with time in both groups.
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Affiliation(s)
- Go Hirabayashi
- Department of Anaesthesiology, Mizonokuchi Hospital Teikyo University School of Medicine, Kanagawa, Japan
- * E-mail:
| | - Yuuki Yokose
- Department of Anaesthesiology, Mizonokuchi Hospital Teikyo University School of Medicine, Kanagawa, Japan
| | - Kohei Nagata
- Department of Anaesthesiology, Mizonokuchi Hospital Teikyo University School of Medicine, Kanagawa, Japan
| | - Hiroyuki Oshika
- Department of Anaesthesiology, Mizonokuchi Hospital Teikyo University School of Medicine, Kanagawa, Japan
| | - Minami Saito
- Department of Anaesthesiology, Mizonokuchi Hospital Teikyo University School of Medicine, Kanagawa, Japan
| | - Yuki Akihisa
- Department of Anaesthesiology, Mizonokuchi Hospital Teikyo University School of Medicine, Kanagawa, Japan
| | - Koichi Maruyama
- Department of Anaesthesiology, Mizonokuchi Hospital Teikyo University School of Medicine, Kanagawa, Japan
| | - Tomio Andoh
- Department of Anaesthesiology, Mizonokuchi Hospital Teikyo University School of Medicine, Kanagawa, Japan
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Michael FA, Peveling-Oberhag J, Herrmann E, Zeuzem S, Bojunga J, Friedrich-Rust M. Evaluation of the Integrated Pulmonary Index® during non-anesthesiologist sedation for percutaneous endoscopic gastrostomy. J Clin Monit Comput 2021; 35:1085-1092. [PMID: 32734356 PMCID: PMC8497449 DOI: 10.1007/s10877-020-00563-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/21/2020] [Indexed: 12/22/2022]
Abstract
Standard monitoring of heart rate, blood pressure and arterial oxygen saturation during endoscopy is recommended by current guidelines on procedural sedation. A number of studies indicated a reduction of hypoxic (art. oxygenation < 90% for > 15 s) and severe hypoxic events (art. oxygenation < 85%) by additional use of capnography. Therefore, U.S. and the European guidelines comment that additional capnography monitoring can be considered in long or deep sedation. Integrated Pulmonary Index® (IPI) is an algorithm-based monitoring parameter that combines oxygenation measured by pulse oximetry (art. oxygenation, heart rate) and ventilation measured by capnography (respiratory rate, apnea > 10 s, partial pressure of end-tidal carbon dioxide [PetCO2]). The aim of this paper was to analyze the value of IPI as parameter to monitor the respiratory status in patients receiving propofol sedation during PEG-procedure. Patients reporting for PEG-placement under sedation were randomized 1:1 in either standard monitoring group (SM) or capnography monitoring group including IPI (IM). Heart rate, blood pressure and arterial oxygen saturation were monitored in SM. In IM additional monitoring was performed measuring PetCO2, respiratory rate and IPI. Capnography and IPI values were recorded for all patients but were only visible to the endoscopic team for the IM-group. IPI values range between 1 and 10 (10 = normal; 8-9 = within normal range; 7 = close to normal range, requires attention; 5-6 = requires attention and may require intervention; 3-4 = requires intervention; 1-2 requires immediate intervention). Results on capnography versus standard monitoring of the same study population was published previously. A total of 147 patients (74 in SM and 73 in IM) were included in the present study. Hypoxic events occurred in 62 patients (42%) and severe hypoxic events in 44 patients (29%), respectively. Baseline characteristics were equally distributed in both groups. IPI = 1, IPI < 7 as well as the parameters PetCO2 = 0 mmHg and apnea > 10 s had a high sensitivity for hypoxic and severe hypoxic events, respectively (IPI = 1: 81%/81% [hypoxic/severe hypoxic event], IPI < 7: 82%/88%, PetCO2: 69%/68%, apnea > 10 s: 84%/84%). All four parameters had a low specificity for both hypoxic and severe hypoxic events (IPI = 1: 13%/12%, IPI < 7: 7%/7%, PetCO2: 29%/27%, apnea > 10 s: 7%/7%). In multivariate analysis, only SM and PetCO2 = 0 mmHg were independent risk factors for hypoxia. IPI (IPI = 1 and IPI < 7) as well as the individual parameters PetCO2 = 0 mmHg and apnea > 10 s allow a fast and convenient conclusion on patients' respiratory status in a morbid patient population. Sensitivity is good for most parameters, but specificity is poor. In conclusion, IPI can be a useful metric to assess respiratory status during propofol-sedation in PEG-placement. However, IPI was not superior to PetCO2 and apnea > 10 s.
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Affiliation(s)
- Florian Alexander Michael
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Jan Peveling-Oberhag
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
- Department of Internal Medicine 1, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Eva Herrmann
- Institute of Biostatistic and Mathematical Modelling, Goethe-University, Frankfurt, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Jörg Bojunga
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
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Stites M, Surprise J, McNiel J, Northrop D, De Ruyter M. Continuous Capnography Reduces the Incidence of Opioid-Induced Respiratory Rescue by Hospital Rapid Resuscitation Team. J Patient Saf 2021; 17:e557-e561. [PMID: 28731933 DOI: 10.1097/pts.0000000000000408] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to determine the impact of end tidal carbon dioxide or capnography monitoring in patients requiring patient-controlled analgesia (PCA) on the incidence of opioid-induced respiratory depression (OIRD) in the setting of rapid response. METHODS A retrospective analysis was conducted in an urban tertiary care facility on the incidence of OIRD in the setting of rapid response as defined by a positive response to naloxone from January 2012 to December 2015. In March 2013, continuous capnography monitoring was implemented for all patients using PCA. RESULTS The preintervention incidence of OIRD in the setting of rapid response was 0.4% of patients receiving opioids. After the implementation of capnography, the incidence of OIRD in the setting of rapid response was reduced to 0.2%, which was statistically significant (χ2 = 46.246; df, 1; P < 0.0001). The rate of transfers to a higher level of care associated with these events was also reduced by 79% (baseline, 7.6 transfers/month; postintervention, 1.6 transfers/month). CONCLUSIONS Continuous capnography monitoring in patients receiving PCA significantly reduces the incidence of OIRD in the setting of rapid response and unplanned transfers to a higher level of care.
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Affiliation(s)
| | | | | | - David Northrop
- Respiratory Therapy Services, The University of Kansas Hospital
| | - Martin De Ruyter
- Department of Anesthesiology, Kansas University Medical Center, Kansas City, Kansas
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Sneyd JR, Cook TM. Waking the dragon: national audit in China and the benefits of having a NAP. Br J Anaesth 2021; 127:2-5. [PMID: 33985790 DOI: 10.1016/j.bja.2021.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- J Robert Sneyd
- Faculty of Medicine and Dentistry, University of Plymouth, Plymouth Science Park, Plymouth, UK.
| | - Tim M Cook
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK; School of Medicine, University of Bristol, Bristol, UK
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Cereceda-Sánchez FJ, Molina-Mula J. Use of supraglottic airway devices under capnography monitoring during cardiopulmonary resuscitation: A systematic review. Aust Crit Care 2021; 34:287-295. [PMID: 33069590 DOI: 10.1016/j.aucc.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/04/2020] [Accepted: 07/11/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bag-valve-mask ventilation is the most commonly applied method during cardiopulmonary resuscitation. Globally, advanced airway management with blind insertion devices such as supraglottic airway devices has been implemented for years by different emergency services. The efficiency of ventilation via such devices could be measured by capnography. OBJECTIVE The objective of this study was to determine whether capnography is useful in patients undergoing cardiopulmonary resuscitation and to assess the effectiveness of ventilation via supraglottic airway devices. REVIEW METHODS USED This is a systematic review written following the steps of Preferred Reporting Items for Systematic Review and Meta-analyses protocols. DATA SOURCES A bibliographic search was carried out from the following databases: EBSCOhost, Scopus, EMBASE, Virtual Health Library, PubMed, Cochrane Library, Spanish Medical Index, Spanish Bibliographic Index in Health Sciences, and Latin American and Caribbean Health Sciences Literature, from inception until September 2019. REVIEW METHODS Studies describing the use of capnography with supraglottic airway devices during cardiopulmonary resuscitation manoeuvres were selected and evaluated using the Critical Appraisal Skills Programme. RESULTS Twenty-four articles were identified by title and abstract: six were randomised clinical trials, 11 were nonrandomised clinical trials, six were descriptive prospective studies, and one was a descriptive retrospective study. Nine primary research articles were selected for synthesis. Only one provided objective values of capnography obtained with ventilation with these devices, correlating them with the results of resuscitation. CONCLUSIONS The evidence published so far is scarce, mostly from observational studies with high risk of bias in general. Although a degree of recommendation cannot be established, some results indicate that capnography has the potential to facilitate advanced clinical practice of ventilation with supraglottic airway devices during cardiopulmonary resuscitation.
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Affiliation(s)
| | - Jesús Molina-Mula
- University of Balearic Islands, Ctra. de Valldemossa, km 7.5, Palma (Islas Baleares), Spain
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41
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Dianti J, Slutsky AS, Goligher EC. Validity of Empirical Estimates of the Ratio of Dead Space to Tidal Volume in ARDS. Respir Care 2021; 66:559-565. [PMID: 33082218 PMCID: PMC9993985 DOI: 10.4187/respcare.08246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The ratio of dead space to tidal volume (VD/VT) is a clinically relevant parameter in ARDS; it has been shown to predict mortality, and it determines the extent to which extracorporeal CO2 removal reduces tidal volume (VT) and driving pressure (ΔP). VD/VT can be estimated with volumetric capnography, but empirical formulas using demographic and physiological information have been proposed to estimate VD/VT without the need of additional equipment. It is unknown whether estimated and measured VD/VT produce similar estimates of the predicted effect of extracorporeal CO2 removal on ΔP. METHODS We performed a secondary analysis of data from a previous clinical trial including subjects with ARDS in whom VD/VT and CO2 production ([Formula: see text]) were measured with volumetric capnography. The estimated ratio of dead space to tidal volume (VD,est/VT) was calculated using standard empiric formulas. Agreement between measured and estimated values was evaluated with Bland-Altman analysis. Agreement between the predicted change in ΔP with extracorporeal CO2 removal as computed using the measured ratio of alveolar dead space to tidal volume (VDalv/VT) or estimated VDalv/VT (VDalv,est/VT) was also evaluated. RESULTS VD,est/VT was higher than measured VD/VT, and agreement between them was low (bias 0.05, limits of agreement -0.21 to 0.31). Differences between measured and estimated [Formula: see text] accounted for 57% of the error in VD,est/VT. The predicted reduction in ΔP with extracorporeal CO2 removal computed using VDalv,est/VT was in reasonable agreement with the expected reduction using VDalv/VT (bias -0.7 cm H2O, limits of agreement -1.87 to 0.47 cm H2O). In multivariable regression, measured VD/VT was associated with mortality (odds ratio 1.9, 95% CI 1.2-3.1, P = .01), but VD,est/VT was not (odds ratio 1.2, 95% CI 0.8-1.8, P = .3). CONCLUSIONS VD/VT and VD,est/VT showed low levels of agreement and cannot be used interchangeably in clinical practice. Nevertheless, the predicted decrease in ΔP due to extracorporeal CO2 removal was similar when computed from either estimated or measured VDalv/VT.
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Affiliation(s)
- Jose Dianti
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Arthur S Slutsky
- Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
- Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada
- Toronto General Hospital Research Institute, Toronto, Canada
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Urman RD, Khanna AK, Bergese SD, Buhre W, Wittmann M, Le Guen M, Overdyk FJ, Di Piazza F, Saager L. Response to: Comment on: Postoperative opioid administration characteristics associated with opioid-induced respiratory depression: Results from the PRODIGY trial. J Clin Anesth 2021; 71:110228. [PMID: 33713932 DOI: 10.1016/j.jclinane.2021.110228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Outcomes Research Consortium, Cleveland, OH, USA.
| | - Sergio D Bergese
- Department of Anesthesiology, and Neurological Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Wolfgang Buhre
- Department of Anesthesiology, University Medical Center, Maastricht, Netherlands
| | - Maria Wittmann
- Department of Anaesthesiology, University Hospital Bonn, Bonn, Germany
| | - Morgan Le Guen
- Department of Anaesthesiology, Hôpital Foch, Suresnes, France
| | | | - Fabio Di Piazza
- Medtronic Core Clinical Solutions, Study and Scientific Solutions, Rome, Italy
| | - Leif Saager
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA; Department of Anesthesiology, University Medical Center Goettingen, Germany
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Fleming L, Gibson D, Hutson D, Ahmadzadeh S, Waddell E, Song S, Reid S, Clark C, Baker JS, Overend R, MacGregor C. Breath emulator for simulation and modelling of expired tidal breath carbon dioxide characteristics. Comput Methods Programs Biomed 2021; 200:105826. [PMID: 33187733 DOI: 10.1016/j.cmpb.2020.105826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND In this work we describe a breath emulator system, used to simulate temporal characteristics of exhaled carbon dioxide (CO2) concentration waveform versus time simulating how much CO2 is present at each phase of the human lung respiratory process. The system provides a method for testing capnometers incorporating fast response non-dispersive infrared (NDIR) CO2 gas sensing devices - in a clinical setting, capnography devices assess ventilation which is the CO2 movement in and out of the lungs. A mathematical model describing the waveform of the expired CO2 characteristic and influence of CO2 gas sensor noise factors and speed of response is presented and compared with measured and emulated data. OBJECTIVE A range of emulated capnogram temporal waveforms indicative of normal and restricted respiratory function demonstrated. The system can provide controlled introduction of water vapour and/ or other gases, simulating the influence of water vapour in exhaled breath and presence of other gases in a clinical setting such as anaesthetic agents (eg N2O). This enables influence of water vapour and/ or other gases to be assessed and modelled in the performance of CO2 gas sensors incorporated into capnography systems. As such the breath emulator provides a means of controlled testing of capnometer CO2 gas sensors in a non-clinical setting, allowing device optimisation before use in a medical environment. METHODS The breath emulator uses a unique combination of mass flow controllers, needle valves and a fast acting switchable pneumatic solenoid valve (FASV), used to controllably emulate exhaled CO2 temporal waveforms for normal and restricted respiratory function. Output data from the described emulator is compared with a mathematical model using a range of input parameters such as time constants associated with inhalation/ exhalation for different parts of the respiratory cycle and CO2 concentration levels. Sensor noise performance is modelled, taking into account input parameters such as sampling period, sensor temperature, sensing light throughput and pathlength. RESULTS The system described here produces realistic human capnographic waveforms and has the capability to emulate various waveforms associated with chronic respiratory diseases and early stage detection of exacerbations. The system has the capability of diagnosing medical conditions through analysis of CO2 waveforms. Demonstrated in this work the emulator has been used to test NDIR gas sensor technology deployed in capnometer devices prior to formal clinical trialling.
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Affiliation(s)
- Lewis Fleming
- Institute of Thin Films, Sensors and Imaging, School of Engineering and Computing, University of the West of Scotland, PA1 2BE Paisley, Scotland, UK.
| | - Des Gibson
- Institute of Thin Films, Sensors and Imaging, School of Engineering and Computing, University of the West of Scotland, PA1 2BE Paisley, Scotland, UK.
| | - David Hutson
- Institute of Thin Films, Sensors and Imaging, School of Engineering and Computing, University of the West of Scotland, PA1 2BE Paisley, Scotland, UK.
| | - Sam Ahmadzadeh
- Institute of Thin Films, Sensors and Imaging, School of Engineering and Computing, University of the West of Scotland, PA1 2BE Paisley, Scotland, UK.
| | - Ewan Waddell
- Institute of Thin Films, Sensors and Imaging, School of Engineering and Computing, University of the West of Scotland, PA1 2BE Paisley, Scotland, UK.
| | - Shigeng Song
- Institute of Thin Films, Sensors and Imaging, School of Engineering and Computing, University of the West of Scotland, PA1 2BE Paisley, Scotland, UK.
| | - Stuart Reid
- The department of Biomedical Engineering, Graham Hills Building, The University of Strathclyde, 50 George Street, Glasgow, G1 1QE, UK.
| | - Caspar Clark
- Helia Photonics Ltd, Unit 2, Rosebank Technology Park, Livingston, EH54 7EJ, UK.
| | - Julien S Baker
- Hong Kong Baptist University, Kowloon Tong, Hong Kong, P R China.
| | - Russell Overend
- Wideblue Ltd, Kelvin Campus, West of Scotland Science Park, Glasgow, G20 0SP.
| | - Calum MacGregor
- Gas Sensing Solutions Ltd, Westfield North Courtyard, Glasgow G68 9HQ, UK.
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Abstract
BACKGROUND The ventilatory ratio (VR) is a dead-space marker associated with mortality in mechanically ventilated adults with ARDS. The end-tidal alveolar dead space fraction (AVDSf) has been associated with mortality in children. However, AVDSf requires capnography measurements, whereas VR does not. We sought to examine the prognostic value of VR, in comparison to AVDSf, in children and young adults with acute hypoxemic respiratory failure. METHODS We conducted a retrospective study of prospectively collected data from 180 mechanically ventilated children and young adults with acute hypoxemic respiratory failure. VR was calculated as (minute ventilation × [Formula: see text])/(age-adjusted predicted minute ventilation × 37.5). AVDSf was calculated as [Formula: see text]. RESULTS VR and AVDSf had a moderate correlation (rho 0.31, P < .001). VR was similar between survivors at 1.22 (interquartile range [IQR] 1.0-1.52) and nonsurvivors at 1.30 (IQR 0.96-1.95) (P = .2). AVDSf was lower in survivors at 0.12 (IQR 0.03-0.23) than nonsurvivors at 0.24 (IQR 0.13-0.33) (P < .001). In logistic regression and competing risk regression analyses, VR was not associated with mortality or rate of extubation at any given time (competing risk death; all P > .3). An AVDSf in the highest 2 quartiles, in comparison to the lowest quartile (AVDSf < 0.06), was associated with higher mortality after adjustment for oxygenation index and severity of illness (AVDSf ≥ 0.15-0.26: odds ratio 3.58, 95% CI 1.02-12.64, P = .047, and AVDSf ≥ 0.26: odds ratio 3.91 95% CI-1.03-14.83, P = .045). At any given time after intubation, a child with an AVDSf ≥ 0.26 was less likely to be extubated than a child with an AVDSf < 0.06, after adjustment for oxygenation index and severity of illness (AVDSf ≥ 0.26: subdistribution hazard ratio 0.55, 95% CI 0.33-0.94, P = .03). CONCLUSIONS VR should not be used for prognostic purposes in children and young adults. AVDSf added prognostic information to the severity of oxygenation defect and overall severity of illness in children and young adults, consistent with previous research.
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Affiliation(s)
- Anoopindar K Bhalla
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California.
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Junzi Dong
- Philips Research North America, Acute Care Solutions Department, Cambridge, Massachusetts
| | - Margaret J Klein
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Robinder G Khemani
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Christopher Jl Newth
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
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Grangeat P, Gharbi S, Koenig A, Comsa MP, Accensi M, Grateau H, Ghaith A, Chacaroun S, Doutreleau S, Verges S. Evaluation in Healthy Subjects of a Transcutaneous Carbon Dioxide Monitoring Wristband during Hypo and Hypercapnia Conditions. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:4640-4643. [PMID: 33019028 DOI: 10.1109/embc44109.2020.9175876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The development of wearable devices for healthcare monitoring is of primary interest, in particular for homecare applications. But it is challenging to develop an evaluation framework to test and optimize such a device by following a non-invasive protocol. As well established reference devices do exist for capnometry, we propose a protocol to evaluate and compare the performance of the transcutaneous carbon dioxide monitoring wristband that we develop. We present here this protocol, the signal processing pipeline and the data analysis based on signal alignment and intercorrelation study, and the first results on a cohort of 13 healthy subjects. This test allows demonstrating the influence of the device response time and of the carbon dioxide content in the ambient air.Clinical Relevance-The protocol described here allows to test and optimize the new device in clinical conditions simulating hypo and hypercapnia variations on a subject at rest, as it would be the case at home to monitor the health status of chronic respiratory patients, and to compare the performances with reference devices. A strong intercorrelation greater than 0.8 has been observed in 5 healthy subjects out of 13 and factors influencing the intercorrelation are suggested.
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46
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Zhang J, Scebba G, Karlen W. Covariance intersection to improve the robustness of the photoplethysmogram derived respiratory rate. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:5939-5942. [PMID: 33019326 DOI: 10.1109/embc44109.2020.9175943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Respiratory rate (RR) can be estimated from the photoplethysmogram (PPG) recorded by optical sensors in wearable devices. The fusion of estimates from different PPG features has lead to an increase in accuracy, but also reduced the numbers of available final estimates due to discarding of unreliable data. We propose a novel, tunable fusion algorithm using covariance intersection to estimate the RR from PPG (CIF). The algorithm is adaptive to the number of available feature estimates and takes each estimates' trustworthiness into account. In a benchmarking experiment using the CapnoBase dataset with reference RR from capnography, we compared the CIF against the state-of-the-art Smart Fusion (SF) algorithm. The median root mean square error was 1.4 breaths/min for the CIF and 1.8 breaths/min for the SF. The CIF significantly increased the retention rate distribution of all recordings from 0.46 to 0.90 (p < 0.001). The agreement with the reference RR was high with a Pearson's correlation coefficient of 0.94, a bias of 0.3 breaths/min, and limits of agreement of -4.6 and 5.2 breaths/min. In addition, the algorithm was computationally efficient. Therefore, CIF could contribute to a more robust RR estimation from wearable PPG recordings.
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Aoyagi T, Kabumoto K, Takatori F, Inoue M. A Novel Nasal Cannula Type Mainstream Capnometer System Capable of Oxygen Administration. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:4450-4453. [PMID: 33018982 DOI: 10.1109/embc44109.2020.9176713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Capnometry is a method to measure carbon dioxide (CO2) in exhaled gas and has been used to monitor patient's respiratory status. During moderate or deep sedation, monitoring for the presence of exhaled CO2 is recommended for evaluating the adequacy of ventilation. Oxygen administration is usually given to patients with a nasal cannula to avoid hypoxia during sedation. However, the flow of oxygen administration can interfere with CO2 measurement. We developed a nasal cannula type adapter called cap-ONE nasal adapter system based on the mainstream capnography which is designed to monitor CO2 while supplying oxygen. In this study, we evaluated the basic performance of the system as compared with a conventional device using a spontaneous breathing model. The cap-ONE nasal adapter system could accurately measure PetCO2 without being disturbed by oxygen flow and efficiently supply oxygen.
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Baba Y, Takatori F, Inoue M, Matsubara I. A Novel Mainstream Capnometer System for Non-invasive Positive Pressure Ventilation. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:4446-4449. [PMID: 33018981 DOI: 10.1109/embc44109.2020.9175950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Capnometry is a method to measure carbon dioxide (CO2) in exhaled gas and it has been used to monitor patient respiratory status. CO2 monitoring is also used for patients receiving non-invasive positive pressure ventilation (NPPV) therapy during mechanical ventilation. Ventilators actively dilute exhaled gas during non-invasive ventilation. In order to accurately measure end-tidal CO2, an adequate amount of expired gas needs to be filled in a CO2 measurement cell before expiratory positive airway pressure (EPAP) gas from the ventilator arrives to the cell. This is the reason why it is difficult to measure CO2 stably during non-invasive ventilation using the conventional CO2 measurement method. Therefore, we developed NPPV cap-ONE mask, which accurately measures CO2 in exhaled gas during non-invasive ventilation. In this study, we evaluated the basic performance of the NPPV cap-ONE mask system. The NPPV cap-ONE mask system could accurately measure CO2 in exhaled gas comparing to the conventional device in this study.
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Bedoya AD, Bhavsar NA, Adagarla B, Page CB, Goldstein BA, MacIntyre NR. Unanticipated Respiratory Compromise and Unplanned Intubations on General Medical and Surgical Floors. Respir Care 2020; 65:1233-1240. [PMID: 32156789 PMCID: PMC7906607 DOI: 10.4187/respcare.07438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Unanticipated respiratory compromise that lead to unplanned intubations is a known phenomenon in hospitalized patients. Most events occur in patients at high risk in well-monitored units; less is known about the incidence, risk factors, and trajectory of patients thought at low risk on lightly monitored general care wards. The aims of our study were to quantify demographic and clinical characteristics associated with unplanned intubations on general care floors and to analyze the medications administered, monitoring strategies, and vital-sign trajectories before the event. METHODS We performed a multicenter retrospective cohort study of hospitalized subjects on the general floor who had unanticipated, unplanned intubations on general care floors from August 2014 to February 2018. RESULTS We identified 448 unplanned intubations. The incidence rate was 0.420 per 1,000 bed-days (95% CI 0.374-0.470) in the academic hospital and was 0.430 (95% CI 0.352-0.520) and 0.394 per 1,000 bed-days (95% CI 0.301-0.506) at our community hospitals. Extrapolating these rates to total hospital admissions in the United States, we estimate 64,000 events annually. The mortality rate was 49.1%. Within 12 h preceding the event, 35.3% of the subjects received opiates. All received vital-sign assessments. Most were monitored with pulse oximetry. In contrast, 2.5% were on cardiac telemetry, and only 4 subjects used capnography; 53.7% showed significant vital-sign changes in the 24 h before the event. However, 46.3% had no significant change in any vital signs. CONCLUSIONS Our study showed unanticipated respiratory compromise that required an unplanned intubation of subjects on the general care floor, although not common, carried a high mortality. Besides pulse oximetry and routine vital-sign assessments, very little monitoring was in use. A significant portion of the subjects had no vital-sign abnormalities leading up to the event. Further research is needed to determine the phenotype of the different etiologies of unexpected acute respiratory failure to identify better risk stratification and monitoring strategies.
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Affiliation(s)
- Armando D Bedoya
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Nrupen A Bhavsar
- Division of General Internal Medicine, Department of Medicine, Duke University
| | | | | | - Benjamin A Goldstein
- Duke Clinical Research Institute
- Department of Biostatistics and Bioinformatics, Duke University
| | - Neil R MacIntyre
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina
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Heidarzadi E, Jalali R, Hemmatpoor B, Salari N. The comparison of capnography and epigastric auscultation to assess the accuracy of nasogastric tube placement in intensive care unit patients. BMC Gastroenterol 2020; 20:196. [PMID: 32571235 PMCID: PMC7306926 DOI: 10.1186/s12876-020-01353-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Placement of nasogastric (NG) tubes is a common procedure for patients especially in intensive care units (ICUs). Thus, it is important to determine the correct placement of the tube to prevent misplacement in the airways. Accordingly, the aim of this study was to compare the epigastric auscultation and capnography in assessing the accuracy of NG tube insertion in ICU patients. METHODS In this descriptive comparative study, 60 patients were selected trough convenience sampling. After insertion of the NG tube in a standard method, the accuracy of placement of the tube with both epigastric auscultation and capnography was investigated. The NG tube insertion accuracy was then confirmed via radiography. Data analysis was performed using statistical software SPSS version 23. RESULTS The result showed that capnography had a sensitivity, specificity, and accuracy of 100, 92.5, and 95% respectively, but epigastric auscultation had 90, 80, and 83.4% respectively. The Kappa agreement coefficient between two methods was - 0.759. CONCLUSION The results revealed that the use of the capnography is preferable over the epigastric auscultation to confirm the correct insertion of the NG tube. It is recommended that more than one method be applied to detect and confirm the correct insertion of the NG tube.
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Affiliation(s)
- Elahe Heidarzadi
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rostam Jalali
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behzad Hemmatpoor
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
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