Transcutaneous carbon dioxide monitoring

McCormack, J. G.; Kelly, K. P.

doi:10.1111/j.1365-2044.2007.05199_1.x

Cited by 1 publication

(1 citation statement)

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“…Less invasive measures of carbon dioxide levels are available but currently not in widespread use. These include bedside capnometry devices, which work by sampling expired carbon dioxide through modified nasal prongs and may be used while administering supplemental oxygen, and techniques used to measure transcutaneous CO 2 85,91,92 . The practical routine clinical use of such devices is still in evolution and has many barriers to overcome, including reliability, cost and patient comfort 93 .…”

Section: Measurement Of Carbon Dioxide Levelsmentioning

confidence: 99%

Opioids, Ventilation and Acute Pain Management

Macintyre

Loadsman

Scott

2011

Anaesth Intensive Care

142

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Despite the increasing use of a variety of different analgesic strategies, opioids continue as the mainstay for management of moderate to severe acute pain. However, concerns remain about their potential adverse effects on ventilation. The most commonly used term, respiratory depression, only describes part of that risk. Opioid-induced ventilatory impairment (OIVI) is a more complete term encompassing opioid-induced central respiratory depression (decreased respiratory drive), decreased level of consciousness (sedation) and upper airway obstruction, all of which, alone or in combination, may result in decreased alveolar ventilation and increased arterial carbon dioxide levels. Concerns about OIVI are warranted, as deaths related to opioid administration in the acute pain setting continue to be reported. Risks are often said to be higher in patients with obstructive sleep apnoea. However, the tendency to use the term ‘obstructive sleep apnoea’ to encompass the much broader spectrum of sleep- and obesity-related hypoventilation syndromes and the related misuse of terminology in papers relating to obstructive sleep apnoea and sleep-disordered breathing remain significant problems in discussions of opioid-related effects. Opioids given for management of acute pain must be titrated to effect for each patient. However, strategies aiming for better pain scores alone, without highlighting the need for appropriate monitoring of OIVI, can and will lead to an increase in adverse events. Therefore, all patients must be monitored appropriately for OIVI (at the very least using sedation scores as a ‘6th vital sign’) so that it can be detected at an early stage and appropriate interventions triggered.

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