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Background: Clearance of tissue carbon dioxide by circulation is measured by venous to arterial carbon dioxide partial pressure difference (AVCO2 ) and is correlated with cardiac output (CO) in critically ill adult patients. This study aimed to correlate AVCO2 with other CO indices like arteriovenous oxygen saturation difference (AVO2 ), central venous oxygen saturation (ScVO2 ), and serum lactate in pediatric patients undergoing intracardiac repair (ICR) for tetralogy of Fallot (TOF). Methods: We conducted a prospective observational study in 50 patients, of age 5months to 5 years, undergoing ICR for TOF and analyzed AVO2 , AVCO2 , ScVO2 , and lactate from arterial and venous blood gas pairs obtained at different time intervals from admission to pediatric intensive care unit(PICU)(T0 ), at 6 h (T1 ), 12 h (T2 ), 24 h (T3 ), and 48 h (T4 ) postoperatively. Bivariate correlations were analyzed using Pearson for parametric variables. Results: Admission AVCO2 was not correlated with AVO2 (R2 = 0.166, P = 0.246), ScVO2 (R2 = ?2.2, P = 0.124), and lactate (R2 = ?0.07, P = 0.624). At T1 , AVCO2 was correlated with AVO2 (R2 = 0.283, P = 0.0464) but not with ScVO2 (R2 = ? 0.25, P = 0.079) and lactate (R2 = ?0.07, P = 0.623). At T2 , T3 and T4 , AVCO2 was correlated with AVO2 (R2 = 0.338,0.440 & 0.318, P = 0.0162, 0.0013, and 0.024), ScVO2 (R2 = ? 0.344, ? 0.488, and ?0.366; P = 0.0143, <0.0001, and 0.017), and lactate (R2 = 0.305, 0.467 and 0.607; P = 0.0314, 0.00062 and <0.0001). AVCO2 was negatively correlated with ScVO2 . No correlation observed between admission AVCO2 and mechanical ventilation duration. Two nonsurvivors had higher value of admission AVCO2 compared to survivors. Conclusion: AVCO2 is correlated with other CO surrogates like AVO2 , ScVO2 , and lactate in pediatric patients undergoing ICR for TOF.
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Objective:To investigate the prognostic value of the ratio of veno-arterial carbon dioxide partial pressure difference to arterio-venous oxygen content difference (Pv-aCO 2/Ca-vO 2) in children with primary peritonitis-related septic shock. Methods:A retrospective study was conducted. Sixty-three children with primary peritonitis-related septic shock admitted to department of intensive care unit of the Children's Hospital Affiliated to Xi'an Jiaotong University from December 2016 to December 2021 were enrolled. The 28-day all-cause mortality was the primary endpoint event. The children were divided into survival group and death group according to the prognosis. The baseline data, blood gas analysis, blood routine, coagulation, inflammatory status, critical score and other related clinical data of the two groups were statistics. The factors affecting the prognosis were analyzed by binary Logistic regression, and the predictability of risk factors were tested by the receiver operator characteristic curve (ROC curve). The risk factors were stratified according to the cut-off, Kaplan-Meier survival curve analysis compared the prognostic differences between the groups.Results:A total of 63 children were enrolled, including 30 males and 33 females, the average age (5.6±4.0) years old, 16 cases died in 28 days, with mortality was 25.4%. There were no significant differences in gender, age, body weight and pathogen distribution between the two groups. The proportion of mechanical ventilation, surgical intervention, vasoactive drug application, and procalcitonin, C-reactive protein, activated partial thromboplastin time, serum lactate (Lac), Pv-aCO 2/Ca-vO 2, pediatric sequential organ failure assessment, pediatric risk of mortality Ⅲ in the death group were higher than those in the survival group. Platelet count, fibrinogen, mean arterial pressure were lower than those in the survival group, and the differences were statistically significant. Binary Logistic regression analysis showed that Lac and Pv-aCO 2/Ca-vO 2 were independent risk factors affecting the prognosis of children [odds ratio ( OR) and 95% confidence interval (95% CI) were 2.01 (1.15-3.21), 2.37 (1.41-3.22), respectively, both P < 0.01]. ROC curve analysis showed that the area under curve (AUC) of Lac, Pv-aCO 2/Ca-vO 2 and their combination were 0.745, 0.876 and 0.923, the sensitivity were 75%, 85% and 88%, and the specificity were 71%, 87% and 91%, respectively. Risk factors were stratified according to cut-off, and Kaplan-Meier survival curve analysis showed that the 28-day cumulative probability of survival of Lac ≥ 4 mmol/L group was lower than that in Lac < 4 mmol/L group [64.29% (18/28) vs. 82.86% (29/35), P < 0.05]. Pv-aCO 2/Ca-vO 2 ≥ 1.6 group 28-day cumulative probability of survival was less than Pv-aCO 2/Ca-vO 2 < 1.6 group [62.07% (18/29) vs. 85.29% (29/34), P < 0.01]. After a hierarchical combination of the two sets of indicator variables, the 28-day cumulative probability of survival of Pv-aCO 2/Ca-vO 2 ≥ 1.6 and Lac ≥ 4 mmol/L group significantly lower than that of the other three groups (Log-rank test, χ2 = 7.910, P = 0.017). Conclusion:Pv-aCO 2/Ca-vO 2 combined with Lac has a good predictive value for the prognosis of children with peritonitis-related septic shock.
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Objective:To investigate the effects of aerosol therapy with budesonide suspension combined with compound ipratropium bromide on partial pressure of carbon dioxide (PaCO 2) and tumor necrosis factor α (TNF-α) in children with bronchiolitis. Methods:A total of 124 children with bronchiolitis admitted to Gujiao Central Hospital from January 2019 to December 2021 were included in this study. These children were randomly divided into two groups using the coin-tossing method. The control group ( n = 62) was treated with routine symptomatic treatment, and the study group ( n = 62) was treated with aerosol therapy of budesonide suspension combined with compound ipratropium bromide based on routine symptomatic treatment. The time at which clinical symptoms disappear, clinical efficacy, inflammatory reaction, and blood gas index were determined in each group. Results:After treatment, the time at which asthma, cough, pulmonary rales, and fever in the study group were (2.28 ± 0.71) days, (3.30 ± 0.82) days, (5.25 ± 1.03) days, and (19.01 ± 2.65) hours, respectively, which were significantly shorter than (2.71 ± 0.89) days, (3.81 ± 0.98) days, (5.72 ± 1.37) days, and (20.76 ± 3.12) hours in the control group ( t = 2.97, 3.14, 2.15, 3.36, all P < 0.05). Total response rate and PaO 2 in the study group were 91.94% and (83.94 ± 4.02) mmHg, respectively, which were significantly higher than 77.42% and (81.25 ± 5.53) mmHg in the control group ( χ2 = 5.03, t = 3.09, both P < 0.05). Interleukin-18, interleukin-33, TNF-α, and PaCO 2 in the study group were (141.03 ± 34.69) ng/L, (143.87 ± 38.43) ng/L, (75.49 ± 18.43) ng/L, and (41.85 ± 3.31) mmHg, respectively, which were significantly lower than (158.64 ± 47.92) ng/L, (162.75 ± 50.32) ng/L, (83.22 ± 21.75) ng/L, and (43.58 ± 4.46) mmHg in the control group ( t = -2.34, -2.34, -3.23, -2.45, all P < 0.05). Conclusion:Aerosol therapy with budesonide suspension combined with compound ipratropium bromide based on routine symptomatic treatment is more effective on bronchiolitis than routine symptomatic treatment alone. The combined therapy can effectively decrease PaCO 2 and TNF-α levels.
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Objective:To investigate the relationship between central venous-arterial blood carbon dioxide partial pressure difference (Pcv-aCO 2) and left ventricular ejection fraction(LVEF) in acute myocardial infarction. Methods:Clinical data of patients with acute myocardial infarction admitted to the Intensive Care Unit of Fujian Provincial Hospital from November 2019 to October 2021 were retrospectively analyzed. LVEF was measured by bedside echocardiogram. The patients were divided into the normal LVEF group (LVEF ≥ 52%) and decreased LVEF group (LVEF < 52%) according to LVEF. The differences in general information and hemodynamic parameters between the two groups were compared. The normality of the above data was tested by the Jarque-Bera test. Correlation analysis of hemodynamic indices with LVEF was performed. Binary logistic regression was used to analyze the risk factors associated with the decrease in LVEF. The feasibility of diagnosing LVEF decline with Pcv-aCO 2 was assessed using receiver operating characteristic (ROC) curve. Results:Seventy-two patients with acute myocardial infarction were included for analysis, including 25 patients in the normal LVEF group and 47 patients in the decreased LVEF group. Pcv-aCO 2 was significantly higher in the decreased LVEF group than that in the normal LVEF group [(7.13±1.19) mmHg vs. (5.41±1.23) mmHg, P<0.01]. There was a negative correlation between LVEF and Pcv-aCO 2 ( rs= -0.740, P<0.01). The area under the ROC curve for Pcv-aCO 2 was 0.849 (95% CI: 0.758-0.939, P<0.01). The binary logistic regression analysis showed that Pcv-aCO 2 was an independent risk factor for decreased LVEF ( OR=2.251, 95% CI: 1.326-3.820). Conclusions:To a certain extent, the increase of Pcv-aCO 2 can predict the decrease of LVEF in acute myocardial infarction.
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OBJECTIVES@#To evaluate the accuracy and safety of measurements of transcutaneous carbon dioxide partial pressure (TcPCO@*METHODS@#A total of 45 very low birth weight infants were enrolled. TcPCO@*RESULTS@#There was no significant difference in TcPCO@*CONCLUSIONS@#Lower electrode temperatures (38-41℃) can accurately measure blood carbon dioxide partial pressure in very low birth weight infants, and thus can be used to replace the electrode temperature of 42°C. Transcutaneous measurements at the lower electrode temperatures may be helpful for understanding the changing trend of blood oxygen partial pressure.
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Humans , Infant , Infant, Newborn , Blood Gas Monitoring, Transcutaneous , Carbon Dioxide , Electrodes , Infant, Very Low Birth Weight , Oxygen , Partial Pressure , TemperatureABSTRACT
Objectives@#Study on the accuracy and influencing factors of neonatal intensive care unit (NICU) critically ill newborns different body parts monitoring by percutaneous oxygen partial pressure (TcpO2) and carbon dioxide partial pressure (TcpCO2), in order to provide a basis for non-invasive monitoring of critically ill newborns in ICU.@*Methods@#60 cases of critically ill newborns requiring blood gas analysis were selected as research cases during July 2017 to March 2018 in Wuxi City Maternity and Child Hospital Neonatology. According to the randomized control principle, three groups were divided, chest group (20 cases), abdomen group (20 cases), leg group (20 cases). The chest group placed the electrodes of the transcutaneous gas analyzer on newborns′ anterior chest. The abdomen group placed the electrodes on newborns′ abdomen. And the leg group placed the electrodes on the inner thigh. PaO2 and PaCO2 values were collected from the blood gas results of critically ill newborns. TcpO2 and TcpCO2 values were recorded. And at the same time, the electrode shedding situation was observed as well. Compare transcutaneous data and arterial blood data, and do analysis.@*Result@#The chest group TcpO2 (69.05±9.17) mmHg(1 mmHg=0.133 kPa), TcpCO2 (46.9±10.57) mmHg, PaO2 (76.4±8.64) mmHg, PaCO2 (40.65±4.74) mmHg, the PaO2 and PaCO2 values were obviously different from the blood gas analysis results (t=-2.608, 2.413, P<0.05). The abdomen group and the leg group had no significant differences (P>0.05) . And the electrode sheet shedding rate was 30% in the chest group, 25% in the abdomen group, and 10% in the leg group, the three groups had no significant differences (χ2=2.553, P>0.05) .@*Conclusion@#NICU critically ill newborns thigh skin monitoring by percutaneous oxygen partial pressure and carbon dioxide partial pressure has high accuracy, and the electrode sheet shedding rate is relatively low. Therefore, it is a safe and effective clinical monitoring method, of great significance for monitoring changes in the condition of critically ill newborns.
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Objective To approach the significance of changes of percutaneous-arterial blood carbon dioxide partial pressure difference [P(tc-a)CO2] in liquid resuscitation of patients with septic shock. Methods One hundred and sixty-eight patients with septic shock admitted and treated in the Department of Intensive Care Unit (ICU) of Quzhou People's Hospital from January 2015 to January 2018 were enrolled, and after early goal-directed therapy (EGDT) for 6 hours, according to central venous oxygen saturation (ScvO2) and lactate clearance (LC), they were divided into ScvO2 and LC achievement group (ScvO2 ≥ 0.7 and LC≥10%), ScvO2 achievement group (ScvO2 ≥ 0.7 and LC < 10%), LC achievement group (ScvO2 < 0.7 and LC≥10%), and un-achievement group (ScvO2 < 0.7 and LC < 10%). The mechanical ventilation time, ICU hospitalization time, 28-day mortality, P(tc-a)CO2 etc. were compared among the four groups; the receiver operating characteristic curve (ROC) was used to evaluate the predictive value of P(tc-a)CO2 for 28-day prognosis in patients with septic shock. Results The trends of mechanical ventilation time, ICU hospitalization time, and 28-day mortality were all ScvO2 and LC achievement group < LC achievement group < ScvO2 achievement group < un-achievement group [the mechanical ventilation times (days) were respectively 6.12±2.59, 8.43±3.24, 11.78±4.12, 13.03±4.75, ICU hospitalization times (days) were 10.31±2.32, 13.85±3.56, 16.41±3.83, 18.52±4.05, and 28-day mortality rates were 28.85% (15/52), 40.91% (18/44), 51.28% (20/39), 69.70% (23/33)] and the differences among the four groups were statistically significant (all P < 0.05). After 6 hours of EGDT, the heart rate (HR), lactate (Lac), and P(tc-a)CO2 were lower than those before fluid resuscitation, but the mean arterial pressure (MAP), central venous pressure (CVP), and ScvO2 were higher than those before fluid resuscitation among four groups. Except CVP, the differences of other indicators compared among the ScvO2 and LC achievement group, ScvO2 achievement group, LC achievement group and un-achievement group were statistically significant (all P < 0.05). After 6 hours of EGDT, HR, Lac, P(tc-a)CO2 in ScvO2 and LC achievement group, ScvO2 achievement group and LC achievement group were significantly lower than those in the un-achievement group [HR (bpm): 89.05±29.43, 98.82±30.21, 94.33±28.64 vs. 112.85±32.74, Lac (mmol/L): 2.97±1.95, 3.87±2.32, 2.69±1.52 vs. 4.17±2.44, P(tc-a)CO2 (mmHg, 1 mmHg = 0133 kPa): 7.18±4.61, 12.61±5.34, 9.71±4.11 vs. 16.56±10.19], MAP and ScvO2 were significantly higher than those of the un-achievement group [MAP (mmHg): 88.05±21.67, 77.33±18.56, 83.11±19.71 vs. 70.32±18.79, ScvO2: 0.76±0.14, 0.75±0.16, 0.67±0.14 vs. 0.63±0.18, all P < 0.05]. The P(tc-a)CO2 of 28 days survivors were significantly lower than that of the deaths among four groups (mmHg: 5.78±2.27 vs. 14.14±3.65, 7.07±2.81 vs. 15.06±4.11, 6.35±2.09 vs. 14.94±4.06, 7.93±3.81 vs. 18.34±4.63, all P < 0.05). When P(tc-a)CO2 > 7.24 mmHg predicted 28-day mortality in ScvO2 and LC achievement group, the sensitivity was 89.29%, specificity was 91.45%, and the area under ROC curve (AUC) was 0.86; when P(tc-a)CO2 > 9.46 mmHg predicted 28-day mortality in LC achievement group, the sensitivity was 88.72%, specificity was 85.83% and AUC was 0.91; when P(tc-a)CO2 >12.05 mmHg predicted 28-day mortality in ScvO2 achievement group, the sensitivity was 82.79%, specificity was 86.90% and AUC was 0.79; when P(tc-a)CO2 > 16.22 mmHg predicted 28-day mortality in un-achievement group, the sensitivity was 73.35%, specificity was 80.68% and AUC was 0.68. Conclusion P(tc-a)CO2 can be used as an indicator to evaluate fluid resuscitation effect and prognosis in patients with septic shock.
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Objectives Study on the accuracy and influencing factors of neonatal intensive care unit (NICU) critically ill newborns different body parts monitoring by percutaneous oxygen partial pressure (TcpO2) and carbon dioxide partial pressure (TcpCO2), in order to provide a basis for non-invasive monitoring of critically ill newborns in ICU. Methods 60 cases of critically ill newborns requiring blood gas analysis were selected as research cases during July 2017 to March 2018 in Wuxi City Maternity and Child Hospital Neonatology. According to the randomized control principle, three groups were divided, chest group (20 cases), abdomen group (20 cases), leg group (20 cases). The chest group placed the electrodes of the transcutaneous gas analyzer on newborns′anterior chest. The abdomen group placed the electrodes on newborns′ abdomen. And the leg group placed the electrodes on the inner thigh. PaO2 and PaCO2 values were collected from the blood gas results of critically ill newborns. TcpO2 and TcpCO2 values were recorded. And at the same time, the electrode shedding situation was observed as well. Compare transcutaneous data and arterial blood data, and do analysis. Result The chest group TcpO2(69.05 ± 9.17)mmHg(1 mmHg=0.133 kPa), TcpCO2( 46.9±10.57)mmHg, PaO(276.4±8.64)mmHg, PaCO(240.65± 4.74)mmHg, the PaO2 and PaCO2 values were obviously different from the blood gas analysis results (t=-2.608, 2.413, P<0.05). The abdomen group and the leg group had no significant differences(P>0.05). And the electrode sheet shedding rate was 30% in the chest group, 25% in the abdomen group, and 10% in the leg group, the three groups had no significant differences(χ2=2.553,P>0.05). Conclusion NICU critically ill newborns thigh skin monitoring by percutaneous oxygen partial pressure and carbon dioxide partial pressure has high accuracy, and the electrode sheet shedding rate is relatively low. Therefore, it is a safe and effective clinical monitoring method, of great significance for monitoring changes in the condition of critically ill newborns.
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Objective To evaluate the accuracy of central venous-to-arterial carbon dioxide partial pressure difference (Pcv-aCO2) before and after rapid rehydration test (fluid challenge) in predicting the fluid responsiveness in patients with septic shock. Methods A prospective observation was conducted. Forty septic shock patients admitted to medical intensive care unit (ICU) of Peking Union Medical College Hospital from October 2015 to June 2017 were enrolled. All of the patients received fluid challenge in the presence of invasive hemodynamic monitoring. Heart rate (HR), blood pressure, cardiac index (CI), Pcv-aCO2 and other physiological variables were recorded at 10 minutes before and immediately after fluid challenge. Fluid responsiveness was defined as an increase in CI greater than 10% after fluid challenge, whereas fluid non-responsiveness was defined as no increase or increase in CI less than 10%. The correlation between Pcv-aCO2 and CI was explored by Pearson correlation analysis. Receiver operating characteristic (ROC) curves were established to evaluate the discriminatory abilities of baseline and the changes after fluid challenge in Pcv-aCO2 and other physiological variables to define the fluid responsiveness. The patients were separated into two groups according to the initial value of Pcv-aCO2. The cut-off value of 6 mmHg (1 mmHg = 0.133 kPa) was chosen according to previous studies. The discriminatory abilities of baseline and the change in Pcv-aCO2(ΔPcv-aCO2) were assessed in each group. Results A total of 40 patients were finally included in this study. Twenty-two patients responded to the fluid challenge (responders). Eighteen patients were fluid non-responders. There was no significant difference in baseline physiological variable between the two groups. Fluid challenge could increase CI and blood pressure significantly, decrease HR notably and had no effect on Pcv-aCO2 in fluid responders. In non-responders, blood pressure was increased significantly and CI, HR, Pcv-aCO2 showed no change after fluid challenge. Pcv-aCO2 was comparable in responders and non-responders. In 40 patients, CI and Pcv-aCO2 was inversely correlated before fluid challenge (r = -0.391, P = 0.012) and the correlation between them weakened after fluid challenge (r = -0.301, P = 0.059). There was no significant correlation between the changes in CI and Pcv-aCO2 after fluid challenge (r = -0.164, P = 0.312). The baseline Pcv-aCO2 and ΔPcv-aCO2 could not discriminate between responders and non-responders, with the area under ROC curve (AUC) of 0.50 [95% confidence interval (95%CI) =0.32-0.69] and 0.51 (95%CI = 0.33-0.70), respectively. HR and blood pressure before fluid challenge and their changes after fluid challenge showed very poor discriminative performances. Before fluid challenge, 16 patients had a Pcv-aCO2 > 6 mmHg. Their mean CI was significantly lower and Pcv-aCO2 was significantly higher than that in 24 patients whose Pcv-aCO2 ≤6 mmHg [n = 24; CI (mL·s-1·m-2): 48.3±11.7 vs. 65.0±18.3, P < 0.01; Pcv-aCO2 (mmHg): 8.4±1.9 vs. 2.9±2.8, P < 0.01]. Pcv-aCO2was decreased significantly after fluid challenge in patients with an initial Pcv-aCO2 > 6 mmHg and their ΔPcv-aCO2 was notably different as compared with the patients whose baseline Pcv-aCO2≤6 mmHg (mmHg: -3.8±3.4 vs. 0.9±2.9, P < 0.01). 68.8% (11/16) patients responded to the fluid challenge in patients with an initial Pcv-aCO2 > 6 mmHg. The AUC of the baseline Pcv-aCO2 and ΔPcv-aCO2 to define fluid responsiveness was 0.85 (95%CI = 0.66-1.00) and 0.84 (95%CI = 0.63-1.00), respectively, and the positive predictive value was 1 when the cut-off value was 8.0 mmHg and -4.2 mmHg, respectively. 45.8% (11/24) patients responded to the fluid challenge in patients whose baseline Pcv-aCO2≤6 mmHg. There was no predictive value of baseline Pcv-aCO2 and ΔPcv-aCO2 on fluid responsiveness. Conclusion Pcv-aCO2 and its change cannot serve as a surrogate of the change in cardiac output to define the response to fluid challenge in septic shock patients whose baseline Pcv-aCO2≤6 mmHg, while the predictive values of baseline Pcv-aCO2and the change in Pcv-aCO2 are presented in patients with the initial value of Pcv-aCO2 > 6 mmHg. Clinical Trial Registration Clinical Trials, NCT01941472.
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Objective To approach the predictive value of continuous monitoring end-tidal carbon dioxide partial pressure (PETCO2) on the outcome of in-hospital cardiopulmonary resuscitation (CPR), and explored the indicators of termination of resuscitation. Methods A secondary analysis of a multicenter observational study data was conducted. The screening aim was adult non-traumatic in-hospital CPR patients whose PETCO2were recorded within 30 minutes of CPR. Clinical information was reviewed. The mean PETCO2in restoration of spontaneous circulation (ROSC) and non-ROSC patients was recorded. The outcome of CPR was continuously assessed by PETCO2≤ 10 mmHg (1 mmHg = 0.133 kPa) for 1, 3, 5, 8, 10 minutes. Receiver operating characteristic (ROC) curve was plotted, and the predictive value of PETCO2≤ 10 mmHg for different duration on the outcome of CPR was evaluated. Results A total of 467 recovery patients, including 419 patients with complete recovery were screened. Patients who were out-of-hospital resuscitation, non-adults, traumatic injury, had no PETCO2value, PETCO2value failed to explained the clinical conditions, or patients had not monitored PETCO2within 30 minutes of resuscitation were excluded, and finally 120 adult patients with non-traumatic in-hospital resuscitation were enrolled in the analysis. The mean PETCO2in 50 patients with ROSC was significantly higher than that of 70 non-ROSC patients [mmHg: 17 (11, 27) vs. 9 (6, 16), P < 0.01]. ROC curve analysis showed that the area under ROC curve (AUC) of PETCO2during the resuscitation for predicting recovery outcome was 0.712 [95% confidence interval (95%CI) = 0.689-0.735]; when the cut-off was 10.5 mmHg, the sensitivity was 57.8%, and the specificity was 78.0%, the positive predictive value (PPV) was 84.6%, and negative predictive value (NPV) was 46.9%. The duration of PETCO2≤ 10 mmHg was used for further analysis, which showed that with PETCO2≤10 mmHg in duration, the prediction of the sensitivity of the patients failed to recover decreased from 58.2% to 28.2%, but specificity increased from 39.4% to 100%; PPV increased from 40% to 100%, and NPV decreased from 57.5% to 34.2%. Conclusion For adult non-traumatic in-hospital CPR patients, continuous 10 minutes PETCO2≤10 mmHg may be an indicate of termination of CPR.
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Objective To analyze the clinical features and related risk factors of sleep hypopnea (SH) in obstructive sleep apnea hypoventilation syndrome (OSAHS). Methods A total of 63 patients with OSAHS who were underwent polysomnography (PSG) and transcutaneous carbon dioxide partial pressure (TCPCO2) monitoring were selected in this study. All patients were divided into pure OSAHS group (n=35) and OSAHS with SH group (n=28) according to the diagnostic criteria of SH. The clinical features of nocturnal carbon dioxide and related risk factors were compared between two groups, including gender, age, complications, body mass index (BMI), Epworth sleepiness scale (ESS), micro awakening index, arterial blood gas analysis, PSG and TCPCO2. Correlation analysis were used to analyze the correlation between the highest TCPCO2 and other variables. The influencing factors of the highest TCPCO2 were analyzed by multiple linear regression analysis. Receiver operating characteristic (ROC) curve analysis was used to analyze the value for related variables in the diagnosis of SH. Results Twenty-eight patients were diagnosed as SH in all the 63 patients with OSAHS, the proportion was 44.4%. There were no significant differences in gender, age and smoking proportion between the two groups. Data of BMI, arterial carbon dioxide partial pressure [p(CO2)], prevalence of hypertension, ESS, apnea hypopnea index, micro arousal index, percentage of nighttime sleep with blood oxygen saturation less than 90%, highest TCPCO2 and TCPCO2 during each sleep stage were significantly higher in the OSAHS with SH group than those in the pure OSAHS group (P<0.05), while arterial oxygen partial pressure [p(O2)] and the lowest pulse oxygen saturation (SpO2) were significantly lower than those in pure OSAHS group (P<0.05). The highest TCPCO2 was positively correlated with p(CO2), ESS and BMI (P<0.01). Multiple linear regression analysis showed that the highest TCPCO2 was affected by BMI and ESS. As a possible predictor for OSAHS with SH, BMI>31.43 kg/m2 showed a sensitivity of 64.3%and specificity of 91.4%, and ESS score>12 showed a sensitivity of 78.6%and specificity of 71.4%. Conclusion The patients of OSAHS with SH have more severe nocturnal hypercapnia and hypoxemia. OSHAS patients are recommend to undergo TcPCO2 monitoring, when BMI is greater than 31.43 kg/m2 and ESS is greater than 12 scores.
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Objective To assess the value of end-tidal carbon dioxide partial pressure (PETCO2) combined passive leg raising (PLR) test on volume responsiveness assessment in shocked patients post cardiac operation.Methods A prospective,self-controlled,and observational study was conducted.The shocked patients post cardiac operation undergoing complete mechanical ventilation admitted to Department of Critical Care Medicine of First Affiliated Hospital of College of Medicine,Zhejiang University from June 2014 to October 2015 were enrolled.PETCO2 and hemodynamic parameters including stroke volume variation (SVV),cardiac index (CI),mean arterial pressure (MAP) monitored by a pulse indicator continuous cardiac output (PiCCO) were determined before and after PLR and volume expansion (VE).Volume responsiveness was defined as an increase in CI (△ CI) of 15％ or greater after VE,namely response group (△ CI ≥ 15％) and non-response group (△ CI ＜ 15％).The value of PLR-induced PETCO2 change (△PETCO2 PLH) to predict volume responsiveness was evaluated by receiver operating.characteristic curves (ROC).Results Among the 41 patients enrolled,21 had volume responsiveness (response group),and 20 had no responsiveness (non-response group).After PLR,the changes in CI and PETCO2 were both significantly increased in the response group compared with non-response group [△ CI:(13.5 ± 4.6)％ vs.(3.6± 3.5)％,△ PETCO2:(7.4 ± 3.4)％ vs.(2.8 ± 2.5)％,both P ＜ 0.05].△ PETCO2 PLR and baseline SVV were positively correlated with PLR-induced CI change (△ CI PLR) (r1 =0.50,r2 =0.38,both P ＜ 0.05).VE-induced PETCO2 change (△ PETCO2 VE),baseline SVV and △ CI PLR were positively correlated with VE-induced CI (△ CI VE) (r1 =0.58,r2 =0.56 and r3 =0.84,all P ＜ 0.01).The area under ROC curve (AUC) of △ PETCO2 PLR was 0.875±0.054 [95％ confidence interval (95％CI) =0.769-0.981,P ＜ 0.05].△ PETCO2 PLR ≥ 5.8％ predicted volume responsiveness with sensitivity of 76.2％ and specificity of 90.0％.AUC of △CI PLR was 0.933±0.036 (95％CI =0.862-1.000,P ＜ 0.05).△CI PLR ≥ 10.4％ predicted volume responsiveness with sensitivity of 81.0％ and specificity of 90.0％.AUC of baseline SVV was 0.831 ±0.066 (95％CI =0.702-0.960,P ＜ 0.05).Baseline SVV ≥ 12.5％ predicted volume responsiveness with sensitivity of 85.7％ and specificity of 75.0％.Conclusion The change in PETCO2 induced by PLR is a convenient,reliable and non-invasive indicator to predict volume responsiveness in shocked patients post cardiac operation with mechanical ventilation.
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Objective To investigate the value of end-tidal carbon dioxide partial pressure (PET CO2 )in fluid resuscitation in severe acute pancreatitis(SAP)patients.Methods SAP patients under mechanical ventilation with the need of a fluid challenge test were included.Hemodynamic parameter cardiac index(CI)and PET CO2 were conducted before and after the fluid challenge test.The value of ΔPET CO2 was used to predict fluid responsiveness. Results Totally 43 patients with SAP were prospectively recruited.31 patients had volume responsiveness, 12 patients had no volume responsiveness.Compared with no volume responsiveness group,volume responsiveness group led to a greater increase in ΔCI[(0.9 ±0.3)vs.(0.2 ±0.3),t =3.24,P <0.05]and ΔPET CO2 [(4.1 ± 1.9)vs.(0.7 ±1.2),t =4.01,P <0.05].ΔPET CO2 and ΔCI were correlated(r =0.74,P <0.05).The area under ROC curve of ΔPET CO2 was 0.872(95% CI 0.754 ~0.923,P <0.05).An increase of 5% in ΔPET CO2 predicted fluid responsiveness with a sensitivity of 86.7%,and specificity of 89.5%.Conclusion The change of ΔPET CO2 induced by fluid challenge test is an effective way to predict fluid responsiveness in SAP patients.
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Objective To reduce the incidence of the hypocapnia,the cutoff value of the end-tidal carbon dioxide partial pressure[Pet(CO2)] for predicting the hypocapnia so as to understand the suitable adjustment target and target range of the Pet(CO2) in preterm infants under mechanical ventilation.Methods From Jan.2012 to Oct.2013,96 cases of the preterm infants with respiratory distress syndrome(RDS) who needed mechanical support were selected from the Huaian Maternity and Child Health Care Hospital.Pet(CO2) value of each time point(1 h,24 h,48 h and 72 h after mechanical ventilation) were recorded,while radial artery blood was collected for blood gas analysis.The level of pa (CO2) ＜ 35 mmHg(1 mmHg =0.133 kPa) diagnosed hypocapnia;while the level of Pa (CO2) ＞ 60 mmHg was for diagnosing hypercapnia.The diagnostic cutoff and the suitable adjustment target and adjustment target range of the Pet(CO2) were confirmed by receiver operating characteristic (ROC) curve.Results The data from 381 arterial blood gas analysis results were gained,of which 151 times belonged to hypocapnia,and the rate was 39.6％,the other 230 cases were normal,and no case was of hypercapnia.The area under the ROC curve was 0.895,and the area of the standard error was 0.016.There was a statistical significance in Pet(CO2) value for the diagnosis of hypocapnia(P =0.000).The lower the value of Pet (CO2),the greater the likelihood of hypocapnia,and 95 ％ confidence interval area was 0.864-0.926.The Pet (CO2) optimal diagnostic cutoff value determined in accordance with Youden index was 30.5 mmHg.When Pet (CO2) among 41.5 mmHg,sensitivity was 100％.Conclusions Diagnostic cutoff value for forecasting hypocapnia is 30.5 mmHg.The suitable adjustment target of mechanical ventilation parameter adjustment is 41.5 mmHg for the Pet(CO2).The target range of mechanical ventilation parameter adjustment is 30.6-41.5 mmHg for the Pet(CO2).
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Objective To assess whether end-tidal carbon dioxide partial pressure (PET CO2) can predict the fluid responsiveness in septic shock patients.Methods Septic shock patients under mechanical ventilation without spontaneous breathing and with the need of a fluid challenge test were included in this study.Heart rate,central venous pressure,pulse pressure,PErCO2,and CI before and after the fluid challenge test were conducted in all the patients.Results Of the 48 septic shock patients included,34 had preload responsiveness,14 had no responsiveness.△CI and △PET CO2 after the fluid challenge test involume responders were (0.85 ± 0.47) L · min-1 · m-2 and (3.5 ± 2.5) mmHg respectively,which were higher than those in no volume responders (P ＜ 0.05).The fluid-induced changes in PET CO2 and CI were correlated (r =0.072,P ＜ 0.05).The AUCRoc of fluid challenge-induced △PET CO2 as the predictor for volume responsiveness was 0.943,and its sensitivity was 87.9％ and specificity was 93.4％ with a critical value of 5％.The AUCRoc of △PP as the predictor for volume responsiveness was 0.801,and its sensitivity was 68.1％ and specificity was 73.2％ with a critical value of 10％.Conclusion The changes of PETCO2 induced by a fluid challenge test can predict fluid responsiveness with reliability,and have a better sensitivity and specificity than the changes of PP.
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Objective To study the clinical significance of end-tidal carbon dioxide partial pressure (PetCO2 ) during cardiopulmonary resuscitation (CPR) and seek the fixed value according which to decide if we should and when to give up.Methods This was a prospective,observational study.A total of 124 patients with cardiac arrest in or out-of-hospital from may 2003 to March 2009 in emergency department of our hospital were selected.All of them had definite etiological factors.Changes of PetCO2 in 124 cardiac arrest patients during CPR were tracked.Results The gender,age,rescue time in seventy-one patients with the return of spontaneous circulation (ROSC) after endotracheal intubation have a significant difference with that in fifty-three patients without ROSC (P ＜0.01 ).The PetCO2 of the survival were higher than that of patients without ROSC or with ROSC,but finally died (P ＜0.01 ).A fixed point 14.4 mmHg of PetCO2 after 20 minutes' CPR can be used as a reference value to guide CPR or predict prognosis.Conclusions Monitoring PetCO2 during CPR has a predictive value on the success of resuscitation.
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Objective To investigate the clinical significance of noninvasive detection of end-tidal carbon dioxide partial pressure (PetCO2) in the management of children with acute asthma, and to evaluate the association between PetCO2 and artery blood gas carbon dioxide partial pressure ( PaCO2 ). Methods This was a prospective,double blinded study of children aged 5 ～ 14 years old treated for acute asthma in a pediatric emergency department. PetCO2 and PaCO2 measurements were taken before therapy and after each nebulization treatment ( maximum of three). Various clinical parametesr were recorded. Patients with PaCO2 and PetCO2 measurements within 8 minutes of each other were eligible for inclusion. Patients with cardiac disease,chronic pulmonary disease, poor tissue perfusion, or metabolic abnormalities were excluded. Results Sixty five children were enrolled. The initial PetCO2 value was (34. 8 ±8. 6) mm Hg (95% confidence interval =34. 0 to 36. 1). The PetCO2 value of post-treatment was (33.2 ±8.2) mm Hg (95% confidence interval =32. 5 to 34. 4) ,which was decreased significantly than that before treatment(P ＜ 0. 01 ). Fifty seven PetCO2-PaCO2 paired values were available from 57 patients. The values of PetCO2 and PaCO2 were ( 34. 8 ±7. 6) mm Hg and (40. 6 ± 8. 3 ) mm Hg, respectively. PetCO2 and PaCO2 values were highly positively correlated ( r = 0. 92,P ＜ 0. 000 1 ). Conclusion Noninvasive bedside measurement of PetCO2 in children with acute asthma in emergency department is feasible. Continuous PetCO2 monitoring can provide a reliable assessment of pulmonary status. PetCO2 can serve as an important adjunct index in the clinical management of pediatric patients with acute asthma.