Uso de la determinación transcutánea de co2 en pacientes con déficit de timidina quinasa 2 y costes de su uso en una consulta de ventilación mecánica no invasiva / Use of transcutaneous co2 determination in patients with thymidine kinase 2 deficit and costs of its use in a noninvasive mechanical ventilation consultation

Objetivo: Describir el uso de la capnografía transcutánea en una población adulta y pediátrica de pacientes con déficit de timidina quinasa 2 y hacer un estudio comparativo de costes de una determinación de gasometría arterial y capnografía en la población de nuestra consulta de VMNI. Metodología: Se realizó una anamnesis y unas pruebas funcionales respiratorias para valorar afectación de la musculatura respiratoria y calidad del sueño. Para determinar la hipoventilación, se midió la pCO2 transcutánea en vigilia y/o durante el sueño. Se realizó un estudio económico para comparar el coste de una determinación de ptcCO2 frente a la determinación mediante GSA. El estudio económico se realizó estimando la población total de pacientes que se valoraba en la consulta de VMNI de manera anual. Resultados: 9 pacientes con déficit de TK2 (4 adultos y 5 niños). A 4 pacientes se les realizó una poligrafía respiratoria basal. A la población pediátrica se les realizó un registro continuo de ptcCO2 con pulsioximetria anual. Se realizaron 4 registros con ptcCO2 y VMNI. Elcoste de la determinación de ptCO2 en comparación con la GSA fue de 6,29 euros frente a 5,37 euros. Conclusiones: La medición de la ptcCO2 es útil en la consulta de VMNI para la realización de medidas puntuales en la consulta como para monitorización continua durante el sueño. Con el uso que realizamos en nuestra consulta de la capnografía transcutánea, la determinación puntual de la pCO2 transcutánea es más económica que la realización de la GSA. (AU)

Objective: to describe the use of transcutaneous capnography in an adult and pediatric population of patients with Thymidine inase 2 deficiency and to compare the costs between blood gases by arterial gasometry (BGA) and capnography in our population. Material and methods: an anamnesis, and respiratory functional tests to assess respiratory muscle involvement, sleep quality were performed.To assess the presence of alveolar hypoventilation the determination of transcutaneous pCO2while awake and/or during sleepwas performed. An economic study has been done to compare the cost of a determination of ptcCO2 versus the determination by BGA. Results: 9 patients with TK2 deficiency (4 adults and 5 children). 4 patients underwent baseline respiratory polygraphy. The pediatric patients underwent at least one continuous recording of ptcCO2 with pulse oximetry each year.4 studies of ptcCO2 duringNIV were performed. The cost in the adult population of a punctual determination of pCO2 by BGA was 6,29 euros while for capnography was 5,37 euros. Conclusions: the measurement of ptcCO2 is useful in the consultation of NIV for the realization of specific measurements in the consultation as for continuous monitoring of this parameter. In our practice of transcutaneous capnography, the punctual determination of transcutaneous pCO2 is cheaper than the BGA. (AU)

Capnographic Monitoring of Moderate Sedation During Low-Risk Screening Colonoscopy Does Not Improve Safety or Patient Satisfaction: A Prospective Cohort Study.

OBJECTIVES: Appropriate monitoring during sedation has been recognized as vital to patient safety in procedures outside of the operating room. Capnography can identify hypoventilation prior to hypoxemia; however, it is not clear whether the addition of capnography improves safety or is cost effective during routine colonoscopy, a high volume, low-risk procedure. Our aim was to evaluate the value of EtCO2 monitoring during colonoscopy with moderate sedation. METHODS: We conducted a prospective study of sedation safety and patient satisfaction before and after the introduction of EtCO2 monitoring during outpatient colonoscopy with midazolam and fentanyl using the validated PROcedural Sedation Assessment Survey (PROSAS). Complications of sedation and PROSAS scores were compared among colonoscopies with and without capnography. RESULTS: A total of 966 patients participated in our study, 465 in the pre-EtCO2 group and 501 in the EtCO2 group. On multivariate analysis, patients and nurses reported higher levels of procedural discomfort after adoption of capnography (1.71 vs. 1.00, P<0.001). No serious adverse events were seen, and minor sedation-related adverse events occurred with similar frequency in both groups (8.2% pre-EtCO2 vs. 11.2% EtCO2, P=0.115). The cost of implementing EtCO2 in our unit was $40,169.95 and added $11.68 per case. CONCLUSIONS: Colonoscopy with moderate sedation is a low-risk procedure, and the addition of EtCO2 did not improve safety or patient satisfaction but did increase cost. These data suggest that routine capnography in this setting may not be cost effective and that EtCO2 might be reserved for patients at higher risk of adverse events.

Comparison of a self-inflating bulb syringe and a colorimetric CO2 indicator with capnography and radiography to detect the misdirection of naso/orogastric tubes into the airway of critically ill adult patients.

OBJECTIVE: The objective of this study was to develop a mechanism of discovering misdirection into the airway of naso/orogastric (NG) tubes before they reach their full depth of placement in adults. METHODS: A prospective, observational study was performed in humans, evaluating both the self-inflating bulb syringe (SIBS) and a colorimetric CO2 detector. A prospective convenience sample of 257 NG tube placements was studied in 199 patients in medical ICUs of a tertiary care medical center. Findings were compared to a "standard" (ie, end tidal CO2 results of a capnograph and the results of a chest radiograph performed at the completion of the tube placement). RESULTS: On the first tube placement attempt in any patient, the SIBS had a sensitivity of 91.5% and a specificity of 87.0% in detecting nonesophageal placement, while the colorimetric device exhibited 99.4% sensitivity and 91.3% specificity. On subsequent insertions, the SIBS showed 95.7% sensitivity and 100% specificity, while the colorimetric device exhibited 97.8% sensitivity and 100% specificity. The colorimetric device was eight times more expensive than the SIBS. CONCLUSIONS: The SIBS and the colorimetric CO2 detector are very good at detecting NG tube malpositioning into the airway, although the colorimetric device is slightly more sensitive and specific. Neither method adds substantial time or difficulty to the insertion process. The colorimetric device is substantially more expensive. The decision as to which method to use may be based on local institutional factors, such as expense.

Capnographic monitoring of ventilatory status during moderate (conscious) sedation.

BACKGROUND: Moderate (conscious) sedation is required to perform endoscopic procedures. Capnography provides a means for continuous, real-time monitoring of ventilation and may also decrease the incidence of oversedation. METHODS: A retrospective examination of all endoscopic procedures performed from January through December 2001 at our institution was undertaken to determine the potential benefits of capnographic monitoring. RESULTS: In 4,846 endoscopic procedures performed without capnography, adverse outcomes related to moderate sedation were noted in 14 cases (0.29%). A subset of patients at higher risk for moderate sedation was identified. There were no cases of oversedation in 600 cases monitored with capnography. The complication rates were not significantly different for the two groups ( p = 0.30, NS). CONCLUSION: The addition of capnography during moderate sedation endoscopy does not appear to significantly lower anesthesia-related morbidity. However, in cases requiring moderate sedation for prolonged procedures, in older patients with comorbidities, or in instances where respiratory excursion of the patient is obscured from view, practitioners should nonetheless consider capnography.

Capnography. A key underutilized technology.

Based on the multiple applications and the potential cost savings, every ICU should have enough capnography for all intubations and probably for all mechanically ventilated patients. Of the multiple clinical applications of capnography, most attention should be focused on its use with intubation and resuscitation. Other applications, such as blood gas and ventilation-perfusion scan reduction, should be instituted after the primary areas have been implemented. While capnography modules may appear to be expensive at first glance, an analysis of their clinical application reveals they can save the hospital hundreds of thousands of dollars beyond the purchase price.