Comparison of ear and chest probes in transcutaneous carbon dioxide pressure measurements during general anesthesia in adults

Article

Abstract

Objective

For transcutaneous carbon dioxide pressure (tcPCO2) measurement, the probe on the trunk or extremities has been used for many years. Our previous study showed that chest was better than arm for tcPCO2 monitoring. Recently, the ear probe has been developed. The accuracy of tcPCO2 as a surrogate measurement of arterial carbon dioxide pressure (PaCO2) has not been compared between the measurement with probe on the chest and measurement with probe on the earlobe. This study compared the accuracy of tcPCO2 measured on the chest and tcPCO2 measured on earlobe during general anesthesia in adults using linear regression analysis and Bland–Altman plot.

Methods

Ten patients aged 30–70 years scheduled for abdominal surgery under general anesthesia were enrolled. TcPCO2 by TCM4™ (Radiometer, Copenhagen, Denmark, TtcPCO2) with its probe on the chest, tcPCO2 by Sentec™ (Sentec AG, Therwil, Switzerland, StcPCO2) with ear probe, end-tidal carbon dioxide pressure (EtCO2), and PaCO2 were simultaneously measured at four different sets of EtCO2 levels in each patient. In total, 40 measurements were performed. The Scatter plot and Bland–Altman plot were obtained. Correlation coefficient (R2) ≥0.70 and limits of agreement ≤4 mmHg were judged as significant.

Results

TtcPCO2 showed significant positive correlation with PaCO2 (R2 = 0.80) but StcPCO2 did not (R2 = 0.55). TtcPCO2 and PaCO2, and StcPCO2 and PaCO2 had large limits of agreement (−6.56 mmHg, 4.21 mmHg and −11.05 mmHg, 7.64 mmHg, respectively). TtcPCO2 and StcPCO2 had no significant correlation (R2 = 0.63) and large limits of agreement (−8.98 mmHg to 7.91 mmHg).

Conclusion

During general anesthesia in adults, both TtcPCO2 and StcPCO2 were not interchangeable with PaCO2, but only TtcPCO2 had good positive correlation with PaCO2.

Keywords

Transcutaneous carbon dioxide pressure Arterial carbon dioxide pressure Earlobe Adults General anesthesia 

References

  1. 1.
    Wimberley PD, Gronlund-Pedersen K, Olsson J, Siggaard-Anderson O. Transcutaneous carbon dioxide and oxygen tension measured at different temperatures in healthy adults. Clin Chem. 1985;31:1611–5.PubMedGoogle Scholar
  2. 2.
    Mahutte CK, Michiels TM, Hassell KT, Trueblood DM. Evaluation of a single transcutaneous PO2–PCO2 sensor in adult patients. Crit Care Med. 1984;12:1063–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Nishiyama T, Nakamura S, Yamashita K. Comparison of the transcutaneous oxygen and carbon dioxide tension in different electrode locations during general anaesthesia. Eur J Anaesthesiol. 2006;23:1049–54.PubMedCrossRefGoogle Scholar
  4. 4.
    Heuss LT, Chhajed PN, Schnieper P, Hirt T, Beglinger C. Combined pulse oximetry/cutaneous carbon dioxide tension monitoring during colonoscopies: pilot study with a smart ear clip. Digestion. 2004;70:152–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Fanelli G, Baciarello M, Squicciarini G, Mailagutti G, Zasa M, Casati A. Transcutaneous carbon dioxide monitoring in spontaneously breathing, nonintubated patients in the early postoperative period. Minerva Anestesiol. 2008;74:375–80.PubMedGoogle Scholar
  6. 6.
    Rodriguez P, Lellouche F, Aboab J, Buisson CB, Brochard L. Transcutaneous arterial carbon dioxide pressure monitoring in critically ill adult patients. Intensive Care Med. 2006;32:309–12.PubMedCrossRefGoogle Scholar
  7. 7.
    Bolliger D, Steiner LA, Kasper J, Aziz OA, Filipovic M, Seeberger MD. The accuracy of non-invasive carbon dioxide monitoring: a clinical evaluation of two transcutaneous systems. Anaesthesia. 2007;62:394–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurements. Lancet. 1986;8476:307–10.CrossRefGoogle Scholar
  9. 9.
    Nishiyama T, Nakamura S, Yamashita K. Effects of the electrode temperature of a new monitor, TCM4, on the measurement of transcutaneous oxygen and carbon dioxide tension. J Anesth. 2006;20:331–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Parker SM, Gibson GJ. Evaluation of a transcutaneous carbon dioxide monitor (“TOSCA”) in adult patients in routine respiratory practice. Resp Med. 2007;101:261–4.CrossRefGoogle Scholar
  11. 11.
    Franklin ML. Transcutaneous measurement of partial pressure of oxygen and carbon dioxide. Respir Care Clin N Am. 1995;1:119–31.PubMedGoogle Scholar
  12. 12.
    Hazinski TA, Severinghaus JW. Transcutaneous analysis of arterial PCO2. Med Instrum. 1982;16:150–3.PubMedGoogle Scholar
  13. 13.
    Lacerenza S, De Carolis MP, Fusco FP, la Torre G, Chiaradia G, Romagnoli C. An evaluation of a new combined SpO2/PtcCO2 sensor in very low birth infants. Anesth Analg. 2008;107:125–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Kagawa S, Severinghaus JW. Errors in monitoring transcutaneous PCO2 on the ear. Crit Care Med. 2005;33:2414–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Bernet V, Doll C, Cannizzaro V, Ersch J, Frey B, Weiss M. Longtime performance and reliability of two different PtcCO2 and SpO2 sensors in neonates. Pediatr Anesth. 2008;18:872–7.CrossRefGoogle Scholar
  16. 16.
    Storre JH, Steurer B, Kabitz HJ, Dreher M, Windisch W. Transcutaneous PCO2 monitoring during initiation of noninvasive ventilation. Chest. 2007;132:1810–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Vogt R, Rohling R, Kastner S. Evaluation of a combined transcutaneous carbon dioxide pressure and pulse oximetry sensor in adult sheep and dogs. Am J Vet Res. 2007;68:265–70.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Anesthesiology and Critical CareHigashi Omiya General HospitalSaitama-shi, SaitamaJapan
  2. 2.TokyoJapan

Personalised recommendations