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. 2018 Sep 19;7(9):290.
doi: 10.3390/jcm7090290.

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

Raisa Rentola  1 , Johanna Hästbacka  2 , Erkki Heinonen  3 , Per H Rosenberg  4 , Tom Häggblom  5 , Markus B Skrifvars  6   7
Affiliations

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

Raisa Rentola et al. J Clin Med. .

Abstract

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.

Keywords: arterial carbon dioxide; blood gas analysis; mechanical ventilation; noninvasive measurement.

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Conflict of interest statement

Authors Erkki Heinonen and Tom Häggblom are employees of GE Healthcare. Markus Skrifvars has received research funding from GE Healthcare and lecture fees from Covidien, Orion Pharma, Axis Shield Diagnostics and BARD. All other authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Bland–Altman plots with 95% limits of agreement with 95% confidence intervals (CIs) demonstrating (a) the difference between the arterial partial pressure of carbon dioxide (PaCO2) (Formula 1) and measured PaCO2, and (b) the difference between PaCO2 (Formula 2) and measured PaCO2.
Figure 2
Figure 2
(a) The differences between estimated PaCO2 (Formula 1) and measured CO2 values at each time point. (b) The differences between estimated PaCO2 (Formula 2) and measured CO2 values at each time point.
Figure 3
Figure 3
(a) The difference between PaCO2 (Formula 1) and measured PaCO2 for each animal. (b) The difference between PaCO2 (Formula 2) and measured PaCO2 for each animal. WSV, within-subject variance; BSV, between-subject variance.
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