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Article Dans Une Revue Respiratory Care Année : 2021

Monitoring Transcutaneously Measured Partial Pressure of CO(2) During Intubation in Critically Ill Subjects

Résumé

BACKGROUND: The risk for severe hypoxemia during endotracheal intubation is a major concern in the ICU, but little attention has been paid to CO(2) variability. The objective of this study was to assess transcutaneously measured partial pressure of CO(2) (P(tcCO(2)) ) 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 CO(2) removal. METHODS: In this single-center, prospective, observational study, we recorded P(tcCO(2)) 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 P(tcCO(2)) variability and the development of postintubation hypotension. RESULTS: A total of 202 subjects were included in the study. The P(tcCO(2)) 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 < .05). P(tcCO(2)) variability differed significantly according to the preoxygenation method (P < .001, linear mixed model). A decrease in P(tcCO(2)) by > 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: P(tcCO(2)) variability during intubation is significant and differs with the method of preoxygenation. A decrease in P(tcCO(2)) after the beginning of mechanical ventilation was associated with postintubation hypotension. (ClinicalTrials.gov registration NCT0388430.).

Dates et versions

hal-03229118 , version 1 (18-05-2021)

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Aurélien Frérou, Adel Maamar, Sonia Rafi, Claire Lhommet, Pierre Phelouzat, et al.. Monitoring Transcutaneously Measured Partial Pressure of CO(2) During Intubation in Critically Ill Subjects. Respiratory Care, 2021, 66 (6), pp.1004-1015. ⟨10.4187/respcare.08009⟩. ⟨hal-03229118⟩
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