Transcutaneous oxygen and CO2 as early warning of tissue hypoxia and hemodynamic shock in critically ill emergency patients

Tatevossian, Raymond; Wo, Charles C.J.; Velmahos, George C.; Δημητριάδης, Δημήτριος; Shoemaker, William C.

doi:10.1097/00003246-200007000-00011

Cited by 93 publications

(71 citation statements)

References 12 publications

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“…Preliminary reports regarding regional CO 2 measurement in sensible microvascular beds, as manifestation of hypoperfusion, are promising [71][72][73]. Measurement of oxygen tension or saturation in certain tissues has permitted the identification of occult hypoperfusion in animal studies and in some limited clinical experiences published [71,[74][75][76][77][78].…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

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Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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“…These authors concluded that PtcO 2 and PtcCO 2 monitoring continuously evaluated tissue perfusion and served as an early warning in critically injured patients during resuscitation immediately after hospital admission. 48 Transfusion Alternatives in Transfusion Medicine VOLUME 6 NUMBER 4 MARCH 2005…”

Section: Near-infrared Spectroscopymentioning

confidence: 99%

Resuscitation Endpoints in Trauma

Napolitano

2005

Transfus Alt Transfus Med

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“…The measurement of transcutaneous P CO 2 (P tcCO 2 ) has been examined in critically ill [14][15][16] or ventilated adults 17,18 and newborns, 19 as well as during bronchoscopy 20 or interhospital ground transport. The aim of our study was to compare P tcCO 2 with P capCO 2 in hypercapnic subjects during the night.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Transcutaneous and Capillary Measurement of P_CO₂in Hypercapnic Subjects

et al. 2015

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BACKGROUND: Measurement of P CO 2 is vital in determining effective alveolar ventilation. However, obtaining capillary P CO 2 by a skin prick of the earlobe is painful, and nocturnal measurements disturb sleep. End-expiratory measurement of P CO 2 is also well established, but there is a low precision in predicting arterial or capillary CO 2 . The purpose of the study was to evaluate nocturnal measurement of noninvasive, transcutaneous P CO 2 (P tcCO 2 ) measurement in hypercapnic subjects. METHODS: In this prospective study, 31 subjects with chronic hypercapnic failure-in a stable phase of the underlying disease-and a control group of 12 healthy volunteers were included. Transcutaneous measurements were taken by the Tosca sensor (Radiometer, Copenhagen, Denmark) over a period of at least 6 h during the night. A capillary blood gas was measured at midnight and 4:00 am. RESULTS: The mean nocturnal capillary P CO 2 (P capCO 2 ) of subjects was 50.6 ؎ 10.2 mm Hg. In the 31 subjects with known hypercapnic respiratory failure, the correlation between P tcCO 2 and P capCO 2 at midnight was 0.86 and at 4:00 am r ‫؍‬ 0.80. The bias of the hypercapnic subjects was d ‫؍‬ ؉ 4.5 with a limit(s) of agreement of 2 SD ‫؍‬ 13.0. The process of blood sampling caused no significant change in P tcCO 2 . CONCLUSIONS: Our study evaluated transcutaneous capnography as a continuous nocturnal measurement in hypercapnic subjects. We found a good agreement between the methods. Because CO 2 is not constant in patients with respiratory failure, but instead fluctuates, we would recommend the continuous transcutaneous measurement of P CO 2 as our method of choice in the diagnosis of nocturnal hypercapnia.

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Transcutaneous oxygen and CO2 as early warning of tissue hypoxia and hemodynamic shock in critically ill emergency patients

Abstract: PtcO2 and PtcCO2 monitoring continuously evaluate tissue perfusion and serve as early warning in critically injured patients during resuscitation immediately after hospital admission.

Cited by 93 publications

References 12 publications

Critical Care Issues in the Early Management of Severe Trauma

Critical Care Issues in the Early Management of Severe Trauma

Resuscitation Endpoints in Trauma

Comparison of Transcutaneous and Capillary Measurement of P_CO₂in Hypercapnic Subjects

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Transcutaneous oxygen and CO2 as early warning of tissue hypoxia and hemodynamic shock in critically ill emergency patients

Abstract: PtcO2 and PtcCO2 monitoring continuously evaluate tissue perfusion and serve as early warning in critically injured patients during resuscitation immediately after hospital admission.

Cited by 93 publications

References 12 publications

Critical Care Issues in the Early Management of Severe Trauma

Critical Care Issues in the Early Management of Severe Trauma

Resuscitation Endpoints in Trauma

Comparison of Transcutaneous and Capillary Measurement of PCO2in Hypercapnic Subjects

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Comparison of Transcutaneous and Capillary Measurement of P_CO₂in Hypercapnic Subjects