Correlation and agreement between transcutaneous carbon dioxide (TcCO₂) and arterial carbon dioxide (PaCO₂) during rapid sequence induction with high-flow nasal oxygen in emergency surgical patients
Main Article Content
Abstract
This prospective study of 105 emergency surgical patients aimed to evaluate the correlation and agreement between transcutaneous carbon dioxide (TcCO2) and arterial carbon dioxide (PaCO2) during rapid-sequence induction with high-flow nasal oxygen (HFNC). TcCO2 was continuously monitored and compared with PaCO2 at predefined time points before preoxygenation, after preoxygenation, and following the apnea period. Statistical analyses included Pearson correlation, linear regression, and Bland–Altman analysis. During apnea, both PaCO2 and TcCO2 increased progressively, with mean rates of 2.07 ± 0.95 mmHg/min and 1.67 ± 0.63 mmHg/min, respectively. TcCO2 showed a moderate positive correlation with PaCO2, with r = 0.63 (p < 0.001) before and after preoxygenation, and r = 0.45 after apnea. Repeated-measures Bland–Altman analysis showed a bias between TcCO2 and PaCO2 of -0.42 mmHg (95% CI: -0.71 to -0.13), with limits of agreement from -4.73 to 3.88 mmHg; the 95% CIs for the lower and upper limits were -5.45 to -4.01 and 3.16 to 4.60 mmHg, respectively.. In conclusion, TcCO2 shows a moderate positive correlation with PaCO2 during rapid sequence induction with HFNC. TcCO2 is useful for continuous monitoring and trend assessment of CO2 changes, but cannot replace arterial blood gas analysis when high accuracy is required.
Article Details
Keywords
Rapid sequence induction, high-flow nasal oxygen, transcutaneous CO2, Apnea
References
2. Tang H, Yang Y, Li H. High-flow nasal cannula for pre- and apneic oxygenation during rapid sequence induction intubation in emergency surgery: A systematic review and meta-analysis. PLoS One. 2025;20(1):e0316918.
3. Gancel PE, Roupie E, Guittet L, et al. Accuracy of a transcutaneous carbon dioxide pressure monitoring device in emergency room patients with acute respiratory failure. Intensive Care Med. 2011;37(2):348-51.
4. Chhajed PN, Chaudhari P, Tulasigeri C, et al. Infraclavicular sensor site: a new promising site for transcutaneous capnography. Scand J Clin Lab Invest. 2012;72(4):340-2.
5. Horvath CM, Brutsche MH, Baty F, et al. Transcutaneous versus blood carbon dioxide monitoring during acute noninvasive ventilation in the emergency department - a retrospective analysis. Swiss Med Wkly. 2016;146:w14373.
6. Don D, Osterbauer B, Nour S, et al. Transcutaneous CO2 Monitoring in Children Undergoing Tonsillectomy for Sleep Disordered Breathing. Laryngoscope. 2021;131(6):1410-5.
7. Ngô Văn Định, Nguyễn Minh Lý, Công Quyết Thắng, và cs. Nghiên cứu mối tương quan giữa nồng độ CO2 máu đo qua da và nồng độ CO2 máu trong khí máu động mạch ở bệnh nhân sử dụng oxy lưu lượng cao khi ngừng thở trong phẫu thuật nội soi dây thanh. Tạp chí Y học Cộng đồng. 2024;65(9).
8. Schweizer T, Hartwich V, Riva T, et al. Limitations of transcutaneous carbon dioxide monitoring in apneic oxygenation. PLoS One. 2023;18(6):e0286038.
9. Liu H, Qu P, Liu Q, et al. High-flow nasal cannula oxygen therapy: physiological basis and clinical applications in anesthesia. Front Med (Lausanne). 2025;12:1661569.
10. Bobbia X, Claret PG, Palmier L, et al. Concordance and limits between transcutaneous and arterial carbon dioxide pressure in emergency department patients with acute respiratory failure: a single-center prospective observational study. Scand J Trauma Resusc Emerg Med. 2015;23:40.