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. 2015 Oct 14;10(10):e0138912.
doi: 10.1371/journal.pone.0138912. eCollection 2015.

Noninvasive Measurement of Carbon Dioxide during One-Lung Ventilation with Low Tidal Volume for Two Hours: End-Tidal versus Transcutaneous Techniques

Hong Zhang  1 , Dong-Xin Wang  1
Affiliations

Noninvasive Measurement of Carbon Dioxide during One-Lung Ventilation with Low Tidal Volume for Two Hours: End-Tidal versus Transcutaneous Techniques

Hong Zhang et al. PLoS One. .

Abstract

Background: There may be significant difference between measurement of end-tidal carbon dioxide partial pressure (PetCO2) and arterial carbon dioxide partial pressure (PaCO2) during one-lung ventilation with low tidal volume for thoracic surgeries. Transcutaneous carbon dioxide partial pressure (PtcCO2) monitoring can be used continuously to evaluate PaCO2 in a noninvasive fashion. In this study, we compared the accuracy between PetCO2 and PtcCO2 in predicting PaCO2 during prolonged one-lung ventilation with low tidal volume for thoracic surgeries.

Methods: Eighteen adult patients who underwent thoracic surgeries with one-lung ventilation longer than two hours were included in this study. Their PetCO2, PtcCO2, and PaCO2 values were collected at five time points before and during one-lung ventilation. Agreement among measures was evaluated by Bland-Altman analysis.

Results: Ninety sample sets were obtained. The bias and precision when PtcCO2 and PaCO2 were compared were 4.1 ± 6.5 mmHg during two-lung ventilation and 2.9 ± 6.1 mmHg during one-lung ventilation. Those when PetCO2 and PaCO2 were compared were -11.8 ± 6.4 mmHg during two-lung ventilation and -11.8 ± 4.9 mmHg during one-lung ventilation. The differences between PtcCO2 and PaCO2 were significantly lower than those between PetCO2 and PaCO2 at all five time-points (p < 0.05).

Conclusions: PtcCO2 monitoring was more accurate for predicting PaCO2 levels during prolonged one-lung ventilation with low tidal volume for patients undergoing thoracic surgeries.

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Conflict of interest statement

Competing Interests: The electrodes and apparatus (TCM3 transcutaneous CO2/oxygen device) used for transcutaneous carbon dioxide partial pressure monitoring in the study were kindly provided by Radiometer Medical Equipment (Shanghai) Co. Ltd. The authors have declared that they have no conflict of interest with the funder in regard to employment, consultancy, patents, products in development, or marketed products. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Agreement between transcutaneous CO2 (PtcCO2) and arterial CO2 (PaCO2).
Bland-Altman analysis of PtcCO2 versus PaCO2 during two-lung ventilation (TLV) and one-lung ventilation (OLV). Bias was labeled. The 95% limits of agreement of the average PtcCO2 –PaCO2 difference during TLV and OLV were 4.1 ± 6.5 mmHg and 2.9 ± 6.1 mmHg (mean ± 1.96 standard deviation), respectively.
Fig 2
Fig 2. Agreement between end-tidal CO2 (PetCO2) and arterial CO2 (PaCO2).
Bland-Altman analysis of PetCO2 versus PaCO2 during two-lung ventilation (TLV) and one-lung ventilation (OLV). Bias was labeled. The 95% limits of agreement of the average PetCO2 –PaCO2 difference during TLV and OLV were -11.8 ± 6.4 mmHg and -11.8 ± 4.9 mmHg (mean ± 1.96 standard deviation), respectively.
See this image and copyright information in PMC

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