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Background The end-tidal partial pressure of carbon dioxide (P ET CO 2 ) can be used to estimate the arterial partial pressure of carbon dioxide (PaCO 2 ) in patients who undergo mechanical ventilation via endotracheal intubation. However, no reliable method for measuring P ET CO 2  during noninvasive ventilation (NIV) has been established. The purpose of this study was to evaluate the correlation and agreement between PaCO 2  and P ET CO 2  measured by these two methods and to compare them in patients who underwent NIV after extubation. Methods This study was a randomized, open-label, crossover trial in a mixed intensive care unit. We included patients who were planned for NIV after extubation and for whom the difference between P ET CO 2  and PaCO 2  was ≤ 5 mmHg. We compared mainstream capnography using an inner cup via face mask (the novel method) with sidestream capnography (the previous method) during NIV. The relationships between PaCO 2  and P ET CO 2  were evaluated by computing the Pearson correlation coefficient, and the agreement between PaCO 2  and P ET CO 2  was estimated using the Bland–Altman method. Results From April 2020 to October 2021, 60 patients were included to the study. PaCO 2  and P ET CO 2  were well correlated in both methods (the novel methods:  r  = 0.92,  P  &lt; 0.001; the previous method:  r  = 0.79,  P  &lt; 0.001). Mean bias between PaCO 2  and P ET CO 2  measured using the novel method was 2.70 (95% confidence interval [CI], 2.15–3.26) mmHg with 95% limits of agreement (LoA) ranging from − 1.61 to 7.02 mmHg, similar to the result of measurement during SBT (mean bias, 2.51; 95% CI, 2.00–3.02; 95% LoA, − 1.45 to 6.47 mmHg). In contrast, measurement using the previous method demonstrated a larger difference (mean bias, 6.22; 95% CI, 5.22–7.23; 95% LoA, − 1.54 to 13.99 mmHg). Conclusion The current study demonstrated that the novel P ET CO 2  measurement was superior to the previous method for PaCO 2  prediction. During NIV, the novel method may collect as sufficient exhalation sample as during intubation. Continuous P ET CO 2  measurement combined with peripheral oxygen saturation monitoring is expected to be useful for early recognition of respiratory failure among high-risk patients after extubation. Trial registration  UMIN-CTR UMIN000039459. Registered February 11, 2020.

journal of intensive care

Accuracy evaluation of mainstream and sidestream end-tidal carbon dioxide monitoring during noninvasive ventilation: a randomized crossover trial (MASCAT-NIV trial)