Continuous non‐invasive <scp>PCO<sub>2</sub></scp> monitoring in weaning patients: <scp>T</scp>ranscutaneous is advantageous over end‐tidal <scp>PCO<sub>2</sub></scp>

Schwarz, Sarah Bettina; Windisch, Wolfram; Magnet, Friederike Sophie; Schmoor, Claudia; Karagiannidis, Christian; Callegari, Jens; Huttmann, Sophie Emilia; Storre, Jan Hendrik

doi:10.1111/resp.13095

Cited by 25 publications

(22 citation statements)

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“…Finally, uncontrolled nocturnal hypoventilation seems to be related to increased risk of exacerbations and pulmonary hypertension [121]. End tidal carbon dioxide monitoring should never be used to approximate P aCO 2 in patients with COPD during spontaneous breathing or NIV, and is even less reliable in patients with invasive ventilation [122,123] In recent years, improvements introduced by manufacturers in their models have led these devices to act both as ventilators and monitors. Data stored in the internal memory of such devices provide information about compliance, pattern of usage, respiratory rate, percentage of patient triggered breaths, leakage and, in some models, "breath to breath" display of pressure and flow time waveforms.…”

Section: Narrative Question 2: How Can Clinicians Monitor and Follow-mentioning

confidence: 99%

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

et al. 2019

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BackgroundWhile the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in COPD, the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. This document provides evidence-based recommendations for the clinical application of LTH-NIV in chronic hypercapnic COPD patients.Materials and methodsThe European Respiratory Society task force committee was composed of clinicians, methodologists and experts in the field of LTH-NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology. The GRADE Evidence to Decision framework was used to formulate recommendations. A number of topics were addressed under a narrative format which provides a useful context for clinicians and patients.ResultsThe task force committee delivered conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode.ConclusionsManaging hypercapnia may be an important intervention for improving the health outcome of COPD patients with chronic respiratory failure. The task force conditionally supports the application of LTH-NIV to improve health outcome by targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPD patients.

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Section: Narrative Question 2: How Can Clinicians Monitor and Follow-mentioning

confidence: 99%

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

et al. 2019

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“…The Severe Respiratory Insufficiency Questionnaire (SRI) was designed and validated for HRQL in patients receiving long-term NIV therapy [27, 28]. Transcutaneous PCO 2 (PtcCO 2 ) (SenTec Digital Monitoring System; VStats-Software®: 4.00; SenTec AG, Therwil, Switzerland) measurements were performed during daytime ventilation in selected patients [29, 30]. …”

Section: Methodsmentioning

confidence: 99%

Is Outpatient Control of Long-Term Non-Invasive Ventilation Feasible in Chronic Obstructive Pulmonary Disease Patients?

et al. 2017

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Background: Long-term non-invasive ventilation (NIV) is an established and increasingly used treatment option for patients with chronic hypercapnic chronic obstructive pulmonary disease (COPD). Following inpatient NIV establishment, inpatient control visits regularly occur thereafter. However, it remains unclear whether such control visits can also be performed in an outpatient setting, which, in turn, would reduce costs, patient burden and the complications related to hospitalization. Objectives: To investigate an outpatient setting with predefined criteria for hospitalization for patients with chronic hypercapnic COPD. Methods: An outpatient clinic located within the hospital in the vicinity of the respiratory care unit provided predefined criteria for hospitalization of COPD patients receiving long-term NIV therapy. The results of this setting were retrospectively analysed. Results: A total of 130 outpatient visits (80 patients) were analysed. In 93 cases (71.5%), hospital admission was not necessary, while hospitalization was performed in 37 cases (28.5%). Out of these, 7 cases with acute conditions required prompt hospitalization. Patients without hospitalization had better PaCO₂ values (45.40 ± 5.27 vs. 50.05 ± 8.04, p = 0.002) and Severe Respiratory Insufficiency Questionnaire Summary scores (55.54 ± 19.74 vs. 41.82 ± 19.59, p = 0.012). Conclusion: Outpatient control of long-term NIV in a hospital setting is feasible and has the capacity to identify stable COPD patients in whom NIV therapy is sufficient according to predefined criteria. These patients may not require hospitalization and may account for more than two thirds of cases.

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“…In addition, PtcCO 2 monitoring is also suggested to be superior over end tidal PCO 2 monitoring because ventilation-perfusion mismatching regularly occurring in ICU patients is suggested to distort PCO 2 measurements when using end tidal monitoring [32][33][34]. However, there was a significant range of the limits of agreement between arterial and transcutaneous PCO 2 measurements in the present study, a range which was even somewhat higher than previously reported in patients receiving mechanical ventilation [32][33][34]. This observation may be attributed to the special clinical scenario with high individual stress levels when performing the intervention and catecholamine treatment.…”

Section: Discussionmentioning

confidence: 99%

Respiratory acidosis during bronchoscopy-guided percutaneous dilatational tracheostomy: impact of ventilator settings and endotracheal tube size

et al. 2019

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Background: The current study investigates the effect of bronchoscopy-guided percutaneous dilatational tracheostomy (PDT) on the evolution of respiratory acidosis depending on endotracheal tube (ET) sizes. In addition, the impact of increasing tidal volumes during the intervention was investigated. Methods: Two groups of ICU-patients undergoing bronchoscopy-guided PDT with varying tidal volumes and tube sizes were consecutively investigated: 6 ml/kg (N = 29, mean age 57.4 ± 14.5 years) and 12 ml/kg predicted body weight (N = 34, mean age 59.5 ± 12.8 years). Results: The mean intervention time during all procedures was 10 ± 3 min. The combination of low tidal volumes and ETs of 7.5 mm internal diameter resulted in the most profound increase in PaCO 2 (32.2 ± 11.6 mmHg) and decrease in pH-value (− 0.18 ± 0.05). In contrast, the combination of high tidal volumes and ETs of 8.5 mm internal diameter resulted in the least profound increase in PaCO 2 (8.8 ± 9.0 mmHg) and decrease of pH (− 0.05 ± 0.04). The intervention-related increase in PaCO 2 was significantly lower when using higher tidal volumes for larger ET: internal diameter 7.5, 8.0 and 8.5: P > 0.05, =0.006 and = 0.002, respectively. Transcutaneous PCO 2 monitoring revealed steadily worsening hypercapnia during the intervention with a high correlation of 0.87 and a low bias of 0.7 ± 9.4 mmHg according to the Bland-Altman analysis when compared to PaCO 2 measurements. Conclusions: Profound respiratory acidosis following bronchoscopy-guided PDT evolves in a rapid and dynamic process. Increasing the tidal volume from 6 to 12 ml/kg PBW was capable of attenuating the evolution of respiratory acidosis, but this effect was only evident when using larger ETs.

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Continuous non‐invasive PCO₂ monitoring in weaning patients: Transcutaneous is advantageous over end‐tidal PCO₂

Abstract: Our data therefore support PtcCO as a suitable means for monitoring PCO in patients undergoing invasive MV. This is in contrast to PetCO , which clearly underestimated PaCO , especially in patients with COPD.

Cited by 25 publications

References 26 publications

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

Is Outpatient Control of Long-Term Non-Invasive Ventilation Feasible in Chronic Obstructive Pulmonary Disease Patients?

Respiratory acidosis during bronchoscopy-guided percutaneous dilatational tracheostomy: impact of ventilator settings and endotracheal tube size

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Continuous non‐invasive PCO2 monitoring in weaning patients: Transcutaneous is advantageous over end‐tidal PCO2

Abstract: Our data therefore support PtcCO as a suitable means for monitoring PCO in patients undergoing invasive MV. This is in contrast to PetCO , which clearly underestimated PaCO , especially in patients with COPD.

Cited by 25 publications

References 26 publications

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

Is Outpatient Control of Long-Term Non-Invasive Ventilation Feasible in Chronic Obstructive Pulmonary Disease Patients?

Respiratory acidosis during bronchoscopy-guided percutaneous dilatational tracheostomy: impact of ventilator settings and endotracheal tube size

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Continuous non‐invasive PCO₂ monitoring in weaning patients: Transcutaneous is advantageous over end‐tidal PCO₂