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[Effects of age, body weight, and ventilatory pattern on the difference between arterial and end-tidal PCO2]
F Colò1, M Girardis, A Pasqualucci
1Cattedra di Anestesia e Rianimazione, Università degli Studi di Udine.
Objective:
To evaluate the effects of physiological ventilatory patterns on P(a-ET)CO2 gradient and on the alveolar dead space production during controlled mechanical ventilation.
Design:
Prospective and experimental comparison among three different ventilatory settings in three different groups of subjects.
Setting:
General surgery's operating-theatre in university hospital.
Patients:
Twenty-eight patients subdivided randomly in 3 groups differing for ventilatory setting. I group: constant tidal volume (VC = 8 ml.kg-1) and 3 different respiratory frequencies (f = 10, 12 and 14 breaths.min-1); II group: constant ventilation (112 ml.kg-1) but VC and f modified in three different ways; III group: inspiratory volume was set to give an end-tidal PCO2 (PETCO2) of about 35 mmHg. The cases were subdivided, on the basis of P(a-ET)CO2 distribution, in three groups: group with values larger than mean plus 1 standard deviation, group with values between +/- 1 standard deviation and group with values lower than mean minus 1 standard deviation. Moreover in two homogeneous groups for age.
Interventions:
General surgery but not important because measures were performed before surgical manoeuvres.
Measurements And Main Results:
Anthropometrical data (age and body weight), PaCO2, PETCO2, heart rate, invasive arterial pressure, ventilatory parameters and airway pressure were collected for every subject and ventilatory setting; arterial to end-tidal difference P(a-ET)CO2 and P(a-ET)CO2.PaCO2(-1) were calculated during data analysis. The P(a-ETFCO2 and P(a-ET)CO2.PaCO2(-1) values were not significantly different among the three different ventilatory patterns both in the first and in the second group. P(a-ET)CO2 values were significantly correlated with age, body weight and airway pressure. These parameters were correlated significantly also with P(a-ET)CO2.PaCO2(-1) values.
Conclusions:
Ventilatory setting, used in a normal physiological range, don't affect P(a-ET)CO2 difference during mechanical ventilation. Age, body weight and airway pressure of the patient must be considered to obtain a correct value of PaCO2 by the measure of PETCO2.