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Intensive Care Medicine
Published in: Intensive Care Medicine 9/2011

01-09-2011 | Experimental

End-inspiratory rebreathing reduces the end-tidal to arterial PCO2 gradient in mechanically ventilated pigs

Authors: Jorn Fierstra, Matthew Machina, Anne Battisti-Charbonney, James Duffin, Joseph Arnold Fisher, Leonid Minkovich

Published in: Intensive Care Medicine | Issue 9/2011

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Abstract

Purpose

Noninvasive monitoring of the arterial partial pressures of CO2 (PaCO2) of critically ill patients by measuring their end-tidal partial pressures of CO2 (PetCO2) would be of great clinical value. However, the gradient between PetCO2 and PaCO2 (Pet-aCO2) in such patients typically varies over a wide range. A reduction of the Pet-aCO2 gradient can be achieved in spontaneously breathing healthy humans using an end-inspiratory rebreathing technique. We investigated whether this method would be effective in reducing the Pet-aCO2 gradient in a ventilated animal model.

Methods

Six anesthetized pigs were ventilated mechanically. End-tidal gases were systematically adjusted over a wide range of PetCO2 (30–55 mmHg) and PetO2 (35–500 mmHg) while employing the end-inspiratory rebreathing technique and measuring the Pet-aCO2 gradient. Duplicate arterial blood samples were taken for blood gas analysis at each set of gas tensions.

Results

PetCO2 and PaCO2 remained equal within the error of measurement at all gas tension combinations. The mean ± SD Pet-aCO2 gradient (0.13 ± 0.12 mmHg, 95% CI −0.36, 0.10) was the same (p = 0.66) as that between duplicate PaCO2 measurements at all PetCO2 and PetO2 combinations (0.19 ± 0.06, 95% CI −0.32, −0.06).

Conclusions

The end-inspiratory rebreathing technique is capable of reducing the Pet-aCO2 gradient sufficiently to make the noninvasive measurement of PetCO2 a useful clinical surrogate for PaCO2 over a wide range of PetCO2 and PetO2 combinations in mechanically ventilated pigs. Further studies in the presence of severe ventilation–perfusion (V/Q) mismatching will be required to identify the limitations of the method.
Appendix
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Metadata
Title
End-inspiratory rebreathing reduces the end-tidal to arterial PCO2 gradient in mechanically ventilated pigs
Authors
Jorn Fierstra
Matthew Machina
Anne Battisti-Charbonney
James Duffin
Joseph Arnold Fisher
Leonid Minkovich
Publication date
01-09-2011
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 9/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-011-2260-y

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