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Am. J. Respir. Crit. Care Med., Volume 161, Number 1, January 2000, 171-176

Capnometric Recirculation Gas Tonometry and Weaning from Mechanical Ventilation

ABEL MALDONADO, TORSTEN T. BAUER, MIQUEL FERRER, CARMEN HERNANDEZ, FRANCISCO ARANCIBIA, ROBERT RODRIGUEZ-ROISIN, and ANTONIO TORRES

Servei de Pneumologia i Al.lèrgia Respiratoria, Departament de Medicina, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Universitat de Barcelona, Barcelona, Spain

The aim of this study was to describe changes in regional intramucosal PCO2 (PrCO2 measured with capnometric recirculation gas tonometry [CRGT]) in patients with acute respiratory failure, who proceed from mechanical ventilation to weaning. In addition, we compared the predictive power for the weaning outcome of CRGT measurements obtained during mechanical ventilation to the frequency/ tidal volume (f/VT) ratio. A total of 24 patients (31 weaning trials) were included in the study, but four of the 24 patients (17%) were excluded because of extubation failure. Of the remaining 27 weaning trials in 20 patients, 12 (44%) were unsuccessful. Changes observed in patients with weaning failure (increase in PrCO2 from 60.4 ± 15.0 mm Hg in mechanical ventilation to 67.4 ± 21.0 mm Hg, in weaning) were significantly different (p = 0.046) from those observed in patients with weaning success (fall in PrCO2 from 61.5 ± 15.0 mm Hg in mechanical ventilation to 56.3 ± 16.7 mm Hg in weaning). However, absolute values of PrCO2 were not significantly different between patients with weaning success and failure, neither during mechanical ventilation (success, 61.5 ± 15.0 versus failure, 60.4 ± 15.0 mm Hg, p = 0.848) nor during weaning (success, 56.3 ± 16.7 versus failure, 67.4 ± 21.0 mm Hg, p = 0.135). The best single predictor for weaning outcome was the f/VT ratio measured early during weaning (area under the curve: 0.844 ± 0.081; adjusted odds ratio for threshold value =< 105: 42.0, 95% CI 3.8 to 469.1, p = 0.002). CRGT could confirm a significant increase in PrCO2 during weaning in patients who finally failed the weaning trial. However, differences between patients with weaning success and failure were small and CRGT did not replace or improve the predictive power of the f/VT ratio for weaning outcome. Maldonado A, Bauer TT, Ferrer M, Hernandez C, Arancibia F, Rodriguez-Roisin R, Torres A. Capnometric recirculation gas tonometry and weaning from mechanical ventilation.




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