비침습적 산소 및 이산화탄소 분압의 감시 - 경피적 산소 및 이산화탄소 분압과 호기말 이산화탄소 분압 측정의 정확도 - (Non-invasive Monitoring of Oxygen and Carbon Dioxide Tension - Accuracy of Transcutaneous O₂ and CO₂ and Endtidal CO₂ -)

서지정보

· 발행기관 : 대한응급의학회
· 수록지 정보 : 대한응급의학회지 / 20권 / 5호 / 481 ~ 487페이지
· 저자명 : 정동민, 문성우, 최성혁, 홍윤식, 이성우, 임성익, 윤영훈

초록

Purpose: To determine the concordance of transcutaneous
CO₂ (PtcCO₂) versus arterial CO₂ (PaCO₂), end-tidal CO₂
(PetCO₂) versus PaCO₂, and transcutaneous O₂ (PtcO₂)
versus arterial O₂ (PaCO₂) among healthy adult volunteers,
and to determine the normal values of the PtcCO₂/PtcO₂
and PtcO₂/PaO₂ that will be used as early signs of shock or
as prognostic factors for critically ill patients.
Methods: We measured the PtcO₂, PtcCO₂, PetCO₂, PaO₂,
and PaCO₂ from 11 healthy volunteers while breathing
room air or O₂ at a flow rate of 6 L/min via nasal cannula.
The PtcO₂ and PtcCO₂ were measured using a
Radiometer’'s transcutaneous sensor that interfaced with
the Solar 8000 patient monitor system. The PetCO₂ was
measured using a side stream capnometer that sampled air
from a nasal catheter. The PaO₂ and PaCO₂ were measured
from arterial blood samples. The concordances of the
PtcCO₂ versus the PaCO₂, the PtcO₂ versus the PaO₂, and
the PetCO₂ versus the PaCO₂ were analyzed using a
Bland-Altman plot. We defined the normal values of the
P(a-tc)CO₂, PtcO₂/PaO₂, and PtcCO₂/PtcO₂.
Results: Twenty-two pairs of the PtcCO₂ versus PaCO₂,
PtcO₂ versus PaO₂, and PetCO₂ versus PaCO₂ were
obtained. The mean (±SD) values of the P(a-tc)CO₂, P(atc)
O₂, and P(a-et)CO₂ were 0(±2.2) mmHg, 35.4(±24.1)
mmHg, and 1.4(±1.3) mmHg, respectively (p=0.947,
p<0.001, and p<0.001 by paired t-test, respectively). The
P(a-tc)CO₂ and P(a-et)CO₂ showed a high concordance of
95.5% within a range of ±4 mmHg. The median (25~75%)
values of the PtcCO₂/PtcO₂ and PtcO₂/PaO₂ at room air
were 54.8%(46.8%~6₂.7%), respectively.
Conclusion: The PtcCO₂ and PetCO₂ had a reliable concordance
with the PaCO₂. However, the PtcO₂ was discordant
with the PaO₂ and this discordance was increased when
inspiring O₂. Therefore, the absolute values of the PtcO₂ cannot
be used as a surrogate measurement of the PaO₂.
However, because the O₂ supply did not increase the
PtcCO₂, but rather the PtcO₂, we can use the trend in the
change in the PtcCO₂/PtcO₂ or PtcO₂/PaO₂ in shock patients

영어초록

Purpose: To determine the concordance of transcutaneous
CO₂ (PtcCO₂) versus arterial CO₂ (PaCO₂), end-tidal CO₂
(PetCO₂) versus PaCO₂, and transcutaneous O₂ (PtcO₂)
versus arterial O₂ (PaCO₂) among healthy adult volunteers,
and to determine the normal values of the PtcCO₂/PtcO₂
and PtcO₂/PaO₂ that will be used as early signs of shock or
as prognostic factors for critically ill patients.
Methods: We measured the PtcO₂, PtcCO₂, PetCO₂, PaO₂,
and PaCO₂ from 11 healthy volunteers while breathing
room air or O₂ at a flow rate of 6 L/min via nasal cannula.
The PtcO₂ and PtcCO₂ were measured using a
Radiometer’'s transcutaneous sensor that interfaced with
the Solar 8000 patient monitor system. The PetCO₂ was
measured using a side stream capnometer that sampled air
from a nasal catheter. The PaO₂ and PaCO₂ were measured
from arterial blood samples. The concordances of the
PtcCO₂ versus the PaCO₂, the PtcO₂ versus the PaO₂, and
the PetCO₂ versus the PaCO₂ were analyzed using a
Bland-Altman plot. We defined the normal values of the
P(a-tc)CO₂, PtcO₂/PaO₂, and PtcCO₂/PtcO₂.
Results: Twenty-two pairs of the PtcCO₂ versus PaCO₂,
PtcO₂ versus PaO₂, and PetCO₂ versus PaCO₂ were
obtained. The mean (±SD) values of the P(a-tc)CO₂, P(atc)
O₂, and P(a-et)CO₂ were 0(±2.2) mmHg, 35.4(±24.1)
mmHg, and 1.4(±1.3) mmHg, respectively (p=0.947,
p<0.001, and p<0.001 by paired t-test, respectively). The
P(a-tc)CO₂ and P(a-et)CO₂ showed a high concordance of
95.5% within a range of ±4 mmHg. The median (25~75%)
values of the PtcCO₂/PtcO₂ and PtcO₂/PaO₂ at room air
were 54.8%(46.8%~6₂.7%), respectively.
Conclusion: The PtcCO₂ and PetCO₂ had a reliable concordance
with the PaCO₂. However, the PtcO₂ was discordant
with the PaO₂ and this discordance was increased when
inspiring O₂. Therefore, the absolute values of the PtcO₂ cannot
be used as a surrogate measurement of the PaO₂.
However, because the O₂ supply did not increase the
PtcCO₂, but rather the PtcO₂, we can use the trend in the
change in the PtcCO₂/PtcO₂ or PtcO₂/PaO₂ in shock patients

참고자료

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