Accession Number:

ADA614808

Title:

Noninvasive Carbon Dioxide Monitoring in a Porcine Model of Acute Lung Injury Due to Smoke Inhalation and Burns

Descriptive Note:

Journal article

Corporate Author:

ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX

Report Date:

2013-01-01

Pagination or Media Count:

7.0

Abstract:

ABSTRACT In critically ill intubated patients, assessment of adequacy of ventilation relies on measuring partial pressure of arterial carbon dioxide PaCO2, which requires invasive arterial blood gas analysis. Alternative noninvasive technologies include transcutaneous CO2 tPCO2 and end-tidal CO2 EtCO2 monitoring. We evaluated accuracy of tPCO2 and EtCO2 monitoring in a porcine model of acute lung injury ALI due to smoke inhalation and burns. Eight anesthetized Yorkshire pigs underwent mechanical ventilation, wood-bark smoke inhalation injury, and 40 total body surface area thermal injury. tPCO2 was measured with a SenTec system SenTec AG, Therwil, Switzerland and EtCO2 with a Capnostream-20 Oridion Medical, Jerusalem, Israel. These values were compared with PaCO2 measurements from an arterial blood gas analyzer. Paired measurements of EtCO2-PaCO2 n 276 and tPCO2-PaCO2 n 250 were recorded in the PaCO2 range of 25 to 85 mmHg. Overlapping data sets were analyzed based on respiratory and hemodynamic status of animals. Acute lung injury was defined as PaO2FIO2 e 300 mmHg hemodynamic instability was defined as mean arterial pressure e 60 mmHg. Before ALI, EtCO2 demonstrated moderate correlation with PaCO2 R2 0.45 P G 0.0001, which deteriorated after onset of ALI R2 0.12 P G 0.0001. Before ALI, tPCO2 demonstrated moderate correlation R2 0.51, P G 0.0001, which was sustained after onset of ALI R2 0.78 P G 0.0001. During hemodynamic stability, EtCO2 demonstrated moderate correlation with PaCO2 R2 0.44 P G 0.0001. During hemodynamic instability, EtCO2 did not correlate with PaCO2 R2 0.03 P 0.29. tPCO2 monitoring demonstrated strong correlation with PaCO2 during hemodynamic stability R2 0.80, P G 0.0001, which deteriorated under hemodynamically unstable conditions R2 0.39 P G 0.0001. Noninvasive carbon dioxide monitors are acceptable for monitoring trends in PaCO2 under conditions of hemodynamic and pulmonary stability. Under unstable c

Subject Categories:

  • Anatomy and Physiology
  • Medicine and Medical Research
  • Inorganic Chemistry

Distribution Statement:

APPROVED FOR PUBLIC RELEASE