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Apnea testing guided by continuous transcutaneous monitoring of partial pressure of carbon dioxide
1Neurological Hospital, University of Erlangen-Nuremberg at Erlangen, Germany.
Objective:
To continuously monitor PCO2 during two different protocols for apnea testing as part of the determination of brain death.
Design:
Prospective comparative study using continuous transcutaneous PCO2 (tcPCO2) monitoring in 54 apnea tests with or without artificial CO2 augmentation. Another 53 apnea tests were not continuously monitored.
Setting:
Intensive care wards in Northern Bavaria.
Patients:
Ninety-six consecutive patients with suspected brain death.
Interventions:
Apnea tests guided by transcutaneous monitoring during a PaCO2 of > or = 60 torr (> or = 8 kPa).
Measurements And Main Results:
The mean of the difference between tcPCO2 and PaCO2 was -0.26 +/- 1.16 (SEM) torr (-0.035 +/- 0.15 kPa). Seventy percent of all transcutaneous measurements were within +/-10% of the PaCO2 values. The individual differences ranged from -25.8 to 16.9 torr (-3.44 to 2.25 kPa).
Conclusions:
While not as precise as could be desired in individual cases, the overall agreement between tcPCO2 and PaCO2 was good. Transcutaneous monitoring aided in effectively reducing the CO2 target overshoot with artificial CO2 augmentation, reduced the necessary number of blood gas checks compared with a former study, using predetermined time-locked evaluations, and prolonged only tests with artificial CO2 augmentation.