Negative arterial to end-tidal CO2 gradients in children

Bhavani-Shankar, Kodali

doi:10.1007/bf03015669

Cited by 5 publications

(4 citation statements)

References 13 publications

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“…Negative PaCO 2 ‐PetCO 2 gradients were obtained within the first 5 min period of HFJV in more than 60% of our study patients. An endtidal CO 2 being higher than arterial CO 2 tensions has been reported previously for conventional as well as high‐frequency jet ventilation ( 19–27). During HFJV, Klein et al ( 10) also found negative gradients of end‐tidal to arterial CO 2 in 17% of measurements.…”

Section: Discussionmentioning

confidence: 60%

Intermittent capnography during high‐frequency jet ventilation for prolonged rigid bronchoscopy

Frietsch¹,

Krafft²,

Becker³

et al. 2000

Acta Anaesthesiol Scand

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Section: Discussionmentioning

confidence: 60%

Intermittent capnography during high‐frequency jet ventilation for prolonged rigid bronchoscopy

Frietsch¹,

Krafft²,

Becker³

et al. 2000

Acta Anaesthesiol Scand

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“…Noninvasive monitoring during paediatric laparoscopy such as S p O 2 and F E H CO 2 are practical methods but F E H CO 2 monitoring is unreliable with rapid respiratory rates, low tidal volumes and the Jackson Rees system [5,23].…”

Section: Discussionmentioning

confidence: 99%

The cardiorespiratory effects of laparoscopic procedures in infants

et al. 1999

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SummaryWe assessed the cardiorespiratory effects of laparoscopic procedures in 27 infants aged between 36 and 365 days. Infants were monitored and anaesthetised in a standardised manner. Heart rate, mean arterial pressure, end-tidal carbon dioxide and oxygen saturation were recorded, and blood gases were measured at 5 min after intubation, 15 and 30 min after carbon dioxide pneumoperitoneum, 5 min after desuf¯ation and after extubation. The pH, P a O 2 , base excess, S a O 2 and S p O 2 decreased, and PCO 2 increased by insuf¯ation of carbon dioxide intraperitoneally, and improved following de¯ation. Changes in pH and P a O 2 during the study were statistically signi®cant (p < 0.0001). The increase in P a CO 2 30 min after pneumoperitoneum was statistically signi®cant when compared with initial values. Transient arrhythmias were observed in 10 infants 1 min after pneumoperitoneum. There were no statistically signi®cant alterations in heart rate and systolic blood pressure.

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“…Setting the respiratory rate to 10 cycles per minute prior to each PACO 2 measurement improved the expiration of long-time constant alveoli. The recruitment of high CO 2 -concentrated alveoli cumulated with the prolongation of expiration, inducing an increased expiratory CO 2 peak, with PACO 2 over-estimating the PaCO 2 [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…Late emptying of well-perfused alveoli with higher CO 2 tensions and better overall ventilation/perfusion matching helped to reduce the gradient between PaCO 2 and PetCO 2 , which became negative in some cases. Negative (a-et) PCO 2 gradients have been reported in infants and children, in pregnant patients, and during exercise [ 11 , 26 ]. This late mechanism may play an important role.…”

Section: Discussionmentioning

confidence: 99%

End-Tidal Carbon Dioxide Pressure Measurement after Prolonged Inspiratory Time Gives a Good Estimation of the Arterial Carbon Dioxide Pressure in Mechanically Ventilated Patients

et al. 2021

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Background: End-tidal carbon dioxide pressure (PetCO2) is unreliable for monitoring PaCO2 in several conditions because of the unpredictable value of the PaCO2–PetCO2 gradient. We hypothesised that increasing both the end-inspiratory pause and the expiratory time would reduce this gradient in patients ventilated for COVID-19 with Acute Respiratory Distress Syndrome and in patients anaesthetised for surgery. Methods: On the occasion of an arterial blood gas sample, an extension in inspiratory pause was carried out either by recruitment manoeuvre or by extending the end-inspiratory pause to 10 s. The end-expired PCO2 was measured (expiratory time: 4 s) after this manoeuvre (PACO2) in comparison with the PetCO2 measured by the monitor. We analysed 67 Δ(a-et)CO2, Δ(a-A)CO2 pairs for 7 patients in the COVID group and for 27 patients in the anaesthesia group. Results are expressed as mean ± standard deviation. Results: Prolongation of the inspiratory pause significantly reduced PaCO2–PetCO2 gradients from 11 ± 5.7 and 5.7 ± 3.4 mm Hg (p < 0.001) to PaCO2–PACO2 gradients of −1.2 ± 3.3 (p = 0.043) and −1.9 ± 3.3 mm Hg (p < 0.003) in the COVID and anaesthesia groups, respectively. In the COVID group, PACO2 showed the lowest dispersion (−7 to +6 mm Hg) and better correlation with PaCO2 (R2 = 0.92). The PACO2 had a sensitivity of 0.81 and a specificity of 0.93 for identifying hypercapnic patients (PaCO2 > 50 mm Hg). Conclusions: Measuring end-tidal PCO2 after prolonged inspiratory time reduced the PaCO2–PetCO2 gradient to the point of obtaining values close to PaCO2. This measure identified hypercapnic patients in both intensive care and during anaesthesia.

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Negative arterial to end-tidal CO2 gradients in children

Cited by 5 publications

References 13 publications

Intermittent capnography during high‐frequency jet ventilation for prolonged rigid bronchoscopy

Intermittent capnography during high‐frequency jet ventilation for prolonged rigid bronchoscopy

The cardiorespiratory effects of laparoscopic procedures in infants

End-Tidal Carbon Dioxide Pressure Measurement after Prolonged Inspiratory Time Gives a Good Estimation of the Arterial Carbon Dioxide Pressure in Mechanically Ventilated Patients

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