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Comparison of mainstream end tidal carbon dioxide on Y-piece side versus patient side of heat and moisture exchanger filters in critically ill adult patients: a prospective observational study
Journal of Clinical Monitoring and Computing ( IF 2.0 ) Pub Date : 2022-08-03 , DOI: 10.1007/s10877-022-00901-6
Satoshi Tamashiro 1, 2 , Izumi Nakayama 3, 4 , Koichiro Gibo 5 , Junichi Izawa 3, 6
Affiliation  

The purpose of the study was to investigate the accuracy of mainstream EtCO2 measurements on the Y-piece (filtered) side of the heat and moisture exchanger filter (HMEF) in adult critically ill patients, compared to that on the patient (unfiltered) side of HMEF. We conducted a prospective observational method comparison study between July 2019 and December 2019. Critically ill adult patients receiving mechanical ventilation with HMEF were included. We performed a noninferiority comparison of the accuracy of EtCO2 measurements on the two sides of HMEF. The accuracy was measured by the absolute difference between PaCO2 and EtCO2. We set the non-inferiority margin at + 1 mmHg in accuracy difference between the two sides of HMEF. We also assessed the agreement between PaCO2 and EtCO2 using Bland–Altman analysis. Among thirty-seven patients, the accuracy difference was − 0.14 mmHg (two-sided 90% CI − 0.58 to 0.29), and the upper limit of the CI did not exceed the predefined margin of + 1 mmHg, establishing non-inferiority of EtCO2 on the Y-piece side of HMEF (P for non-inferiority < 0.001). In the Bland–Altman analyses, 95% limits of agreement between PaCO2 and EtCO2 were similar on both sides of HMEF (Y-piece side, − 8.67 to + 10.65 mmHg; patient side, − 8.93 to + 10.67 mmHg). The accuracy of mainstream EtCO2 measurements on the Y-piece side of HMEF was noninferior to that on the patient side in critically ill adults. Mechanically ventilated adult patients could be accurately monitored with mainstream EtCO2 on the Y-piece side of the HMEF unless their tidal volume was extremely low.



中文翻译:


危重成年患者热湿交换过滤器 Y 形件侧与患者侧主流呼气末二氧化碳的比较:一项前瞻性观察研究



本研究的目的是调查成人危重患者热湿交换过滤器 (HMEF) Y 形件(过滤)侧主流 EtCO 2测量值与患者(未过滤)侧测量值的准确性HMEF。我们在 2019 年 7 月至 2019 年 12 月之间进行了一项前瞻性观察方法比较研究。纳入了接受 HMEF 机械通气的危重成年患者。我们对 HMEF 两侧的 EtCO 2测量精度进行了非劣效性比较。准确度通过PaCO 2和EtCO 2之间的绝对差来测量。我们将 HMEF 两侧准确度差异的非劣效裕度设置为 + 1 mmHg。我们还使用 Bland-Altman 分析评估了 PaCO 2和 EtCO 2之间的一致性。在 37 名患者中,准确度差异为 − 0.14 mmHg(双侧 90% CI − 0.58 至 0.29),CI 上限未超过 + 1 mmHg 的预定界限,证明 EtCO 的非劣效性2在 HMEF 的 Y 形件一侧( P表示非劣效性 < 0.001)。在 Bland-Altman 分析中,HMEF 两侧的 PaCO 2和 EtCO 2之间的 95% 一致性限度相似(Y 形件侧,− 8.67 至 + 10.65 mmHg;患者侧,− 8.93 至 + 10.67 mmHg)。在危重成人中,HMEF Y 形件侧主流 EtCO 2测量的准确性不低于患者侧。 机械通气成年患者可以通过 HMEF Y 形件侧的主流 EtCO 2进行准确监测,除非他们的潮气量极低。

更新日期:2022-08-04
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