An Evaluation of Transcutaneous Carbon Dioxide Partial Pressure Monitoring during Apnea Testing in Brain-dead Patients

2006 ◽  
Vol 104 (4) ◽  
pp. 701-707 ◽  
Author(s):  
Benoîit Vivien ◽  
Frédéric Marmion ◽  
Sabine Roche ◽  
Catherine Devilliers ◽  
Olivier Langeron ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Partial Pressure ◽  
Test Group ◽  
Carbon Dioxide Partial Pressure ◽  
Arterial Oxygen ◽  
Apnea Test ◽  
Transcutaneous Carbon Dioxide ◽  
Arterial Blood ◽  
The Mean ◽  
Brain Dead

Background Diagnosis of brain death usually requires an arterial carbon dioxide partial pressure (Paco2) of 60 mmHg during the apnea test, but the increase in Paco2 is unpredictable. The authors evaluated whether transcutaneous carbon dioxide partial pressure (Ptcco2) monitoring during apnea test can predict that a Paco2 of 60 mmHg has been reached. Methods The authors compared Ptcco2 measured with a transcutaneous ear sensor (V-Sign Sensor, Sentec Digital Monitoring System; SENTEC-AG, Therwil, Switzerland) and Paco2 obtained from arterial blood gas measurements in 32 clinically brain-dead patients. Results In the first 20 patients, the mean Paco2-Ptcco2 gradient was 0.7 +/- 3.6 mmHg at baseline and 8.7 +/- 7.1 mmHg after 20 min of apnea. Using receiver operating characteristic curve analysis (area under the curve: 0.983 +/- 0.013), the best threshold value of Ptcco2 to predict that a Paco2 of 60 mmHg had been reached was 60 mmHg (positive predictive value: 1.00 [0.93-1.00]). In the following 12 patients investigated with use of this Ptcco2 target value of 60 mmHg, the mean duration of the apnea test (11 +/- 4 vs. 20 +/- 0 min; P < 0.001), hypercapnia (74.0 +/- 4.9 vs. 98.3 +/- 20.0 mmHg; P < 0.001), acidosis (pH: 7.18 +/- 0.06 vs. 7.11 +/- 0.08; P < 0.001), and decrease in arterial oxygen partial pressure (-47 +/- 44 vs. -95 +/- 89; P < 0.05) at the end of the test were reduced as compared with the 20-min apnea test group. Conclusion During the apnea test in brain-dead patients, a Ptcco2 of 60 mmHg accurately predicts that a Paco2 of 60 mmHg has been reached. This may allow a reduction in the duration of the apnea test and consecutively limit occurrence of complications.

scholarly journals Electrocardiographic study on geriatric dogs undergoing general anesthesia with isoflurane

2008 ◽  
Vol 39 (2) ◽  
pp. 453-459
Author(s):  
Andreza Conti-Patara ◽  
Denise Tabacchi Fantoni ◽  
Silvia Renata Gaido Cortopassi
Keyword(s):  
Carbon Dioxide ◽  
Oxygen Saturation ◽  
Partial Pressure ◽  
Normal Sinus Rhythm ◽  
Arterial Oxygen Saturation ◽  
Carbon Dioxide Partial Pressure ◽  
Arterial Oxygen ◽  
T Wave ◽  
Arterial Blood ◽  
St Segment

The purpose of this study was to clarify the degree of influence of anesthetic agents commonly used during anesthesia on the heart conduction systems of geriatric dogs, with or without the presence of electrocardiographic changes in the pre-anesthetic electrocardiogram and also to determine the possible causes of ST-segment and T-wave changes during anesthesia, by monitoring ventilation and oxygenation. 36 geriatric dogs were evaluated. In addition to electrocardiographic evaluation, the pre-anesthetic study included serum levels of urea, creatinine, total protein, albumin and electrolytes. The pre-anesthetic medication consisted of acepromazine (0.05mg kg-1) in association with meperidine (3.0mg kg-1) by IM injection. Anesthesia was induced with propofol (3.0 to 5.0mg kg-1) by IV injection and maintained with isoflurane in 100% oxygen. During the anesthesia, the animals were monitored by continued computerized electrocardiogram. Systemic blood pressure, heart rate, respiratory rate, end-tidal carbon dioxide, partial pressure of carbon dioxide in arterial blood, arterial oxygen saturation, partial pressure of arterial oxygen and oxygen saturation of hemoglobin were closely monitored. During maintenance anesthesia, normal sinus rhythm was more common (78%). ST-segment and T-wave changes during the anesthetic procedure were quite common and were related to hypoventilation. The use of isoflurane did not result in arrhythmia, being therefore a good choice for this type of animal; Electrocardiographic findings of ST-segment and T-wave changes during the maintenance anesthesia were evident in animals with hypercapnia, a disorder that should be promptly corrected with assisted or controlled ventilation to prevent complicated arrhythmias.

scholarly journals Optimal Duration of the Apnea Test for Determining Brain Death: Benefit of the Short-Term Apnea Test

2021 ◽  
Author(s):  
Seung Min Baik ◽  
Jin Park ◽  
Tae Yoon Kim ◽  
Jung Hwa Lee ◽  
Kyung Sook Hong
Keyword(s):  
Carbon Dioxide ◽  
Blood Pressure ◽  
Brain Death ◽  
Partial Pressure ◽  
Arterial Blood Pressure ◽  
Mean Arterial Blood Pressure ◽  
Apnea Test ◽  
Arterial Blood ◽  
Brain Death Determination ◽  
The Mean

Abstract Background: The criteria for brain death determination have not been unified globally, and there is no global consensus on the apnea test, which is essential for determining brain death. Since the apnea test is associated with many complications, we aimed to determine an optimal duration of the apnea test.Methods: We analyzed the results of the apnea test performed for brain death determination between August 2013 and February 2021 at a single institution in South Korea. Elevations in the partial pressure of carbon dioxide and mean arterial blood pressure fluctuations over time in the apnea test were recorded.Results: In the 1st and 2nd tests, the mean partial pressure of carbon dioxide increased by more than 20 mmHg at 3 min after the apnea test compared to before the test (P < 0.05). At 4 min in the 1st test and 5 min in the 2nd test, the partial pressure of carbon dioxide exceeded 60 mmHg (P < 0.05). The fluctuation in the mean arterial blood pressure observed for 5 min during the apnea test was not significant. There was no significant fluctuation in the mean arterial blood pressure over time in the apnea test between patients with normal chest radiography findings and those with abnormal chest radiography findings (P = 0.888).Conclusion: Our study proposes that a short-term apnea test protocol is valid for the preservation of organs for donation.

Transcutaneous carbon-dioxide partial pressure trends during six-minute walk test in patients with very severe COPD

2016 ◽  
Vol 233 ◽  
pp. 52-59 ◽  
Author(s):  
Vasileios Andrianopoulos ◽  
Lowie E.G.W Vanfleteren ◽  
Inga Jarosch ◽  
Rainer Gloeckl ◽  
Tessa Schneeberger ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Partial Pressure ◽  
Carbon Dioxide Partial Pressure ◽  
Walk Test ◽  
Transcutaneous Carbon Dioxide ◽  
Six Minute Walk Test ◽  
Minute Walk ◽  
Severe Copd

Cardiopulmonary and acid–Base effects of desflurane and sevoflurane in spontaneously breathing cats

2005 ◽  
Vol 7 (2) ◽  
pp. 95-100 ◽  
Author(s):  
Almir Pereira Souza ◽  
Piedad Natalia Henao Guerrero ◽  
Celina Tie Nishimori ◽  
Danielli Parrilha Paula ◽  
Paulo Sergio Patto Santos ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Partial Pressure ◽  
Arterial Oxygen Saturation ◽  
Respiratory Acidosis ◽  
Ion Concentration ◽  
Arterial Oxygen ◽  
Normal Limits ◽  
Arterial Blood ◽  
Short Period ◽  
End Tidal

The cardiopulmonary effects of desflurane and sevoflurane anesthesia were compared in cats breathing spontaneously. Heart (HR) and respiratory (RR) rates; systolic (SAP), diastolic (DAP) and mean arterial (MAP) pressures; partial pressure of end tidal carbon dioxide (PETCO2), arterial blood pH (pH), arterial partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2); base deficit (BD), arterial oxygen saturation (SaO2) and bicarbonate ion concentration (HCO3) were measured. Anesthesia was induced with propofol (8±2.3 mg/kg IV) and maintained with desflurane (GD) or sevoflurane (GS), both at 1.3 MAC. Data were analyzed by analysis of variance (ANOVA), followed by the Tukey test ( P<0.05). Both anesthetics showed similar effects. HR and RR decreased when compared to the basal values, but remained constant during inhalant anesthesia and PETCO2 increased with time. Both anesthetics caused acidemia and hypercapnia, but BD stayed within normal limits. Therefore, despite reducing HR and SAP (GD) when compared to the basal values, desflurane and sevoflurane provide good stability of the cardiovascular parameters during a short period of inhalant anesthesia (T20–T60). However, both volatile anesthetics cause acute respiratory acidosis in cats breathing spontaneously.

Late surfactant replacement therapy and its efficacy on severe bronchopulmonary dysplasia in National Children Hospital

2021 ◽  
Vol 148 (12) ◽  
pp. 152-157
Author(s):  
Nguyen Thi Quynh Nga ◽  
Nguyen Thi Van
Keyword(s):  
Partial Pressure ◽  
Bronchopulmonary Dysplasia ◽  
Premature Infants ◽  
Prolonged Mechanical Ventilation ◽  
Surfactant Therapy ◽  
Arterial Oxygen ◽  
Oxygen Requirement ◽  
Arterial Blood ◽  
Surfactant Replacement Therapy ◽  
The Mean

Bronchopulmonary dysplasia (BPD) is a chronic lung disease that is most commonly seen in premature infants who require prolonged mechanical ventilation and oxygen therapy. 75% of intubated infants have episodes of dysfunctional surfactants associated with lower levels of surfactant proteins. This study aims to evaluate the effectiveness of late surfactant therapy in treating BPD in premature infants. Nineteen preterm infants diagnosed with severe BPD requiring mechanic ventilation, according to Jobe and Bancalari, were treated with surfactant (Poractant alpha 100mg/kg intra-tracheal). Patients were observed for change in oxygen requirement before and at 1-h, 6-h, 12-h, 24-h, and 48-h after treatment. There were 13 boys and 6 girls; boy to girl ratio was 2.16/1. The mean gestation age was 28.3 ± 2 weeks; the mean birth weight was 1134.7 ± 314 gram. There was an increase in SpO2 (saturation of peripheral oxygen), PaO2 (the partial pressure of oxygen in arterial blood) and reduction in FiO2 (fraction of inspired oxygen), PaCO2 (the partial pressure of carbon dioxide in arterial blood), OI (oxygen index), MAP (mean airway pressure) and AaDO2 (Alveolar-to-arterial oxygen gradient) after surfactant (p < 0.05). Conclusion: In patients with severe BPD, late surfactant therapy has shown initial benefits in lung functions and reducing oxygen requirement.

scholarly journals Estimation of Arterial Carbon Dioxide Based on End-Tidal Gas Pressure and Oxygen Saturation

2018 ◽  
Vol 7 (9) ◽  
pp. 290 ◽  
Author(s):  
Raisa Rentola ◽  
Johanna Hästbacka ◽  
Erkki Heinonen ◽  
Per Rosenberg ◽  
Tom Häggblom ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Oxygen Saturation ◽  
Partial Pressure ◽  
Traditional Method ◽  
Mean Difference ◽  
Mechanically Ventilated ◽  
Arterial Carbon Dioxide ◽  
Arterial Blood ◽  
The Mean ◽  
End Tidal

Arterial blood gas (ABG) analysis is the traditional method for measuring the partial pressure of carbon dioxide. In mechanically ventilated patients a continuous noninvasive monitoring of carbon dioxide would obviously be attractive. In the current study, we present a novel formula for noninvasive estimation of arterial carbon dioxide. Eighty-one datasets were collected from 19 anesthetized and mechanically ventilated pigs. Eleven animals were mechanically ventilated without interventions. In the remaining eight pigs the partial pressure of carbon dioxide was manipulated. The new formula (Formula 1) is PaCO2 = PETCO2 + k(PETO2 − PaO2) where PaO2 was calculated from the oxygen saturation. We tested the agreements of this novel formula and compared it to a traditional method using the baseline PaCO2 − ETCO2 gap added to subsequently measured, end-tidal carbon dioxide levels (Formula 2). The mean difference between PaCO2 and calculated carbon dioxide (Formula 1) was 0.16 kPa (±SE 1.17). The mean difference between PaCO2 and carbon dioxide with Formula 2 was 0.66 kPa (±SE 0.18). With a mixed linear model excluding cases with cardiorespiratory collapse, there was a significant difference between formulae (p < 0.001), as well as significant interaction between formulae and time (p < 0.001). In this preliminary animal study, this novel formula appears to have a reasonable agreement with PaCO2 values measured with ABG analysis, but needs further validation in human patients.

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