RT Journal Article
SR Electronic
T1 Monitoring Transcutaneously Measured Partial Pressure of CO<sub>2</sub> During Intubation in Critically Ill Subjects
JF Respiratory Care
FD American Association for Respiratory Care
SP 1004
OP 1015
DO 10.4187/respcare.08009
VO 66
IS 6
A1 Frérou, Aurélien
A1 Maamar, Adel
A1 Rafi, Sonia
A1 Lhommet, Claire
A1 Phelouzat, Pierre
A1 Pontis, Emmanuel
A1 Reizine, Florian
A1 Lesouhaitier, Mathieu
A1 Camus, Christophe
A1 Le Tulzo, Yves
A1 Tadié, Jean-Marc
A1 Gacouin, Arnaud
YR 2021
UL http://rc.rcjournal.com/content/66/6/1004.abstract
AB BACKGROUND: The risk for severe hypoxemia during endotracheal intubation is a major concern in the ICU, but little attention has been paid to CO2 variability. The objective of this study was to assess transcutaneously measured partial pressure of CO2 ( ) throughout intubation in subjects in the ICU who received standard oxygen therapy, high-flow nasal cannula oxygen therapy, or noninvasive ventilation for preoxygenation. We hypothesized that the 3 methods differ in terms of ventilation and CO2 removal.METHODS: In this single-center, prospective, observational study, we recorded from preoxygenation to 3 h after the initiation of mechanical ventilation among subjects requiring endotracheal intubation. Subjects were sorted into 3 groups according to the preoxygenation method. We then assessed the link between variability and the development of postintubation hypotension.RESULTS: A total of 202 subjects were included in the study. The values recorded at endotracheal intubation, at the initiation of mechanical ventilation, and after 30 min and 1 h of mechanical ventilation were significantly higher than those recorded during preoxygenation (P &lt; .05). variability differed significantly according to the preoxygenation method (P &lt; .001, linear mixed model). A decrease in by &gt; 5 mm Hg within 30 min after the start of mechanical ventilation was independently associated with postintubation hypotension (odds ratio = 2.14 [95% CI 1.03–4.44], P = .039) after adjustments for age, Simplified Acute Physiology Score II, COPD, cardiac comorbidity, the use of propofol for anesthetic induction, and minute ventilation at the start of mechanical ventilation.CONCLUSIONS: variability during intubation is significant and differs with the method of preoxygenation. A decrease in after the beginning of mechanical ventilation was associated with postintubation hypotension. (ClinicalTrials.gov registration NCT0388430.)