Capnography facilitates tight control of ventilation during transport


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Abstract

Objective We tested the hypothesis that PaCO2 would be more tightly controlled if end-tidal CO2 monitoring was used during hand ventilation for transport of intubated patients.Design Randomized, prospective analysis of the no-monitor and monitor-blind groups (the monitor was on the bed during transport but only the investigator was aware of the end-tidal CO2 values). Nonrandomized, prospective analysis of the monitor group (ventilation controlled using end-tidal CO2 value from monitor).Setting University hospital operating room and intensive care unit (ICU).Patients Fifty intubated patients who were transported from the operating room to the ICU or from the ICU to the neuroradiology suite were assigned randomly to one of two groups: a) no-monitor group (n equals 25); and b) monitor-blind group (n equals 25). An additional group (monitor group, n equals 10) was subsequently added to the study.Interventions Capnography was instituted in all patients in a blocked fashion.Measurements and Main Results Arterial blood gases and end-tidal CO2 values were measured before and after transport. When comparing overall group data, pre- and post-PaCO2 values were similar: monitor 39 plus minus 2 vs. 41 plus minus 2 torr (5.2 plus minus 0.3 vs. 5.5 plus minus 0.3 kPa); monitor-blind 39 plus minus 1 vs. 39 plus minus 2 torr (5.2 plus minus 0.1 vs. 5.2 plus minus 0.3 kPa); no-monitor 39 plus minus 1 vs. 37 plus minus torr (5.2 plus minus 0.1 vs. 5.0 plus minus 0.1 kPa). However, when comparing PaCO2 values for individual patients, we found that there was significantly greater variability for PaCO2 after transport when end-tidal CO2 was not used for control of ventilation during transport.Conclusions These data do not support routine monitoring of end-tidal CO2 during short transport times in adult patients requiring mechanical ventilation. However, the monitor may prevent morbidity in patients requiring tight control of PaCO2.(Crit Care Med 1996; 24:608-611)

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