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Transcutaneous Carbon Dioxide Monitoring During Acute Respiratory Distress Syndrome Due to Smoke Inhalation and Burns
Author(s) -
Belenkiy Slava,
Ivey Katherine,
Batchinsky Andriy,
Langer Tom,
Necsoiu Corina,
Vecchi Vittoria,
Baker William,
Chung Kevin,
Salinas Jose,
Cancio Lee
Publication year - 2012
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.26.1_supplement.lb825
Subject(s) - ards , smoke inhalation , medicine , inhalation , anesthesia , hemodynamics , carboxyhemoglobin , smoke , respiratory system , respiratory distress , cardiology , lung , chemistry , organic chemistry , biochemistry , carbon monoxide , catalysis
We evaluated the accuracy of continuous noninvasive transcutaneous carbon dioxide (tPCO2) monitoring utilizing the SenTec Digital Monitoring System in a model of ARDS due to smoke inhalation and burns. Subjects anesthetized female Yorkshire pigs (47.4 ± 0.9 kg) received wood bark smoke inhalation injury and 40% total body surface area full thickness flame burn. A SenTec sensor heated to 43.5°C was used. Correlation of tPCO2 with arterial PaCO2 measured intermittently with i‐STAT blood gas analyzer. Results all animals developed ARDS at 23±2.08 hrs. Mean survival time was 51±14.9 hrs. A total of 88 paired measurements of PaCO2 and tPCO2 were performed. The mean overall bias between PaCO2 and tPCO2 under stable conditions (Bland‐Altman analysis (BAa)) was 0.75±5.34 mm Hg with overall correlation (R2 = 0.79, P<0.0001). Eighty‐nine percent of measurements were within the acceptable clinical range of agreement of ± 7.5mm Hg. This relationship deteriorated under hemodynamic instability with overall bias increasing to 17.3±18.5 mm Hg (BAa) and poor correlation (R2= 0.02, P=0.53) and only 33% of measurements were within the acceptable clinical range of agreement. Conclusions Transcutaneous CO2 monitoring is a reliable surrogate for PaCO2 in the setting of severe lung injury and hemodynamic stability. Additional information must be considered during hemodynamic instability for accurate estimation of PaCO2.