RT Journal Article
SR Electronic
T1 Can transcutaneous carbon dioxide pressure be a surrogate of blood gas samples for spontaneously breathing emergency patients? The ERNESTO experience
JF Emergency Medicine Journal
JO Emerg Med J
FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine
SP emermed-2015-205203
DO 10.1136/emermed-2015-205203
A1 Nicolas Peschanski
A1 Léa Garcia
A1 Emilie Delasalle
A1 Lynda Mzabi
A1 Edwin Rouff
A1 Sandrine Dautheville
A1 Fayrouz Renai
A1 Yann Kieffer
A1 Guillaume Lefevre
A1 Yonathan Freund
A1 Patrick Ray
YR 2015
UL http://emj.bmj.com/content/early/2015/12/30/emermed-2015-205203.abstract
AB Background It is known that the arterial carbon dioxide pressure (PaCO2) is useful for emergency physicians to assess the severity of dyspnoeic spontaneously breathing patients. Transcutaneous carbon dioxide pressure (PtcCO2) measurements could be a non-invasive alternative to PaCO2 measurements obtained by blood gas samples, as suggested in previous studies. This study evaluates the reliability of a new device in the emergency department (ED).Methods We prospectively included patients presenting to the ED with respiratory distress who were breathing spontaneously or under non-invasive ventilation. We simultaneously performed arterial blood gas measurements and measurement of PtcCO2 using a sensor placed either on the forearm or the side of the chest and connected to the TCM4 CombiM device. The agreement between PaCO2 and PtcCO2 was assessed using the Bland–Altman method.Results Sixty-seven spontaneously breathing patients were prospectively included (mean age 70 years, 52% men) and 64 first measurements of PtcCO2 (out of 67) were analysed out of the 97 performed. Nineteen patients (28%) had pneumonia, 19 (28%) had acute heart failure and 19 (28%) had an exacerbation of chronic obstructive pulmonary disease. Mean PaCO2 was 49 mm Hg (range 22–103). The mean difference between PaCO2 and PtcCO2 was 9 mm Hg (range −47 to +54) with 95% limits of agreement of −21.8 mm Hg and 39.7 mm Hg. Only 36.3% of the measurement differences were within 5 mm Hg.Conclusions Our results show that PtcCO2 measured by the TCM4 device could not replace PaCO2 obtained by arterial blood gas analysis.