Abstract
Introduction
Transcutaneous measurement of gases depends on the degree of skin perfusion. Mechanical ventilation causes alteration in the peripheral perfusion. The aim of this prospective observational study was to assess change in the accuracy of interchangeability of arterial blood gases with those obtained transcutaneously at various phases of mechanical ventilation such as controlled mandatory, synchronized intermittent mandatory, continuous positive airway pressure ventilations, spontaneous breathing trail and spontaneous ventilation after extubation of endotracheal tube.
Methods
Thirty-two adult patients who underwent uncomplicated off pump coronary artery bypass surgery in a tertiary care medical center were subjected to transcutaneous measurements of gases from the sensor placed on the chest during postoperative ventilation. Arterial blood gas analysis was performed at predetermined time intervals and transcutaneous measurements were repeated each of those time.
Results
Fifty-four sets of data were obtained during controlled ventilation and fifty during spontaneous. Correlation coefficient for oxygen increased from 0.46 (P = 0.0004) during controlled ventilation to 0.75 (P < 0.0001) during spontaneous. Bland–Altman and mountain plots suggested better inter- changeability of values between arterial blood gas and transcutaneous gas monitoring. The bias for oxygen changed from 21 during controlled ventilation to 25 during spontaneous ventilation and the precision from 7.1 to 6.4. There was no change in the accuracy of transcutaneous carbon dioxide values during either phase of ventilation.
Conclusion
The accuracy of transcutaneously measured values of oxygen improved significantly during spontaneous ventilation.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Eberhard P. The design, use, and results of transcutaneous carbon dioxide analysis: current and future directions. Anesth Analg. 2007;105(6 Suppl):S48–52.
Duke GJ. Cardiovascular effects of mechanical ventilation. Crit Care Resusc. 1999;1(4):388–99.
Edner A, Nyman G, Essén-Gustavsson B. The effects of spontaneous and mechanical ventilation on central cardiovascular function and peripheral perfusion during isoflurane anaesthesia in horses. Vet Anaesth Analg. 2005;32(3):136–46.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.
Krouwer JS, Monti KL. A simple, graphical method to evaluate laboratory assays. Eur J Clin Chem Clin Biochem. 1995;33:525–7.
McCormack JG, Kelly KP, Wedgwood J, Lyon R. The effects of different analgesic regimens on transcutaneous CO2 after major surgery. Anaesthesia. 2008;63(8):814–21.
Yamada T, Ohta T, Ishibashi H, Sugimoto I, Iwata H, Takahashi M, et al. Clinical reliability and utility of skin perfusion pressure measurement in ischemic limbs—comparison with other noninvasive diagnostic methods. J Vasc Surg. 2008;47(2):318–23.
McBride ME, Berkenbosch JW, Tobias JD. Transcutaneous carbon dioxide monitoring during diabetic ketoacidosis in children and adolescents. Paediatr Anaesth. 2004;14(2):167–71.
Chakravarthy M, Narayan S, Govindarajan R, Jawali V, Rajeev S. Weaning mechanical ventilation following off pump coronary artery bypass graft procedure directed by non invasive gas measurement—a prospective study. J Cardiothorac Vasc Anesth (in print).
Chakravarthy M, Narayan S, Govindarajan R, Rajeev S, Jawali V. Early non invasive detection of hypercarbia in two cardiac surgical patients. J Clin Monit Comput. 2009;23(1):59–61.
Garcia E, Abramo TJ, Okada P, Guzman DD, Reisch JS, Wiebe RA. Capnometry for noninvasive continuous monitoring of metabolic status in pediatric diabetic ketoacidosis. Crit Care Med. 2003;31(10):2539–43.
Kopka A, Wallace E, Reilly G, Binning A. Observational study of perioperative PtcCO2 and SpO2 in non-ventilated patients receiving epidural infusion or patient-controlled analgesia using a single earlobe monitor (TOSCA). Br J Anaesth. 2007;99(4):567–71.
Author information
Authors and Affiliations
Corresponding author
Additional information
Chakravarthy M, Narayan S, Govindarajan R, Jawali V. Improvement in accuracy of transcutaneous measurement of oxygen with resumption of spontaneous ventilation in mechanically ventilated patients after off pump coronary artery bypass procedure: a prospective study.
Rights and permissions
About this article
Cite this article
Chakravarthy, M., Narayan, S., Govindarajan, R. et al. Improvement in accuracy of transcutaneous measurement of oxygen with resumption of spontaneous ventilation in mechanically ventilated patients after off pump coronary artery bypass procedure: a prospective study. J Clin Monit Comput 23, 363–368 (2009). https://doi.org/10.1007/s10877-009-9207-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10877-009-9207-7