• Nicolas Peschanski, Léa Garcia, Emilie Delasalle, Lynda Mzabi, Edwin Rouff, Sandrine Dautheville, Fayrouz Renai, Yann Kieffer, Guillaume Lefevre, Yonathan Freund, and Patrick Ray.
• Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire Tenon Saint Antoine, Assistance-Publique Hôpitaux de Paris (AP-HP), Paris, France Department of Emergency Medicine, Centre Hospitalo-Universitaire Rouen, Rouen, France Institut National de la Sante et de la Recherche Médicale U1096, Université de Rouen, Rouen, France.
• Emerg Med J. 2016 May 1; 33 (5): 325-8.

BackgroundIt is known that the arterial carbon dioxide pressure (PaCO2) is useful for emergency physicians to assess the severity of dyspnoeic spontaneously breathing patients. Transcutaneous carbon dioxide pressure (PtcCO2) measurements could be a non-invasive alternative to PaCO2 measurements obtained by blood gas samples, as suggested in previous studies. This study evaluates the reliability of a new device in the emergency department (ED).MethodsWe prospectively included patients presenting to the ED with respiratory distress who were breathing spontaneously or under non-invasive ventilation. We simultaneously performed arterial blood gas measurements and measurement of PtcCO2 using a sensor placed either on the forearm or the side of the chest and connected to the TCM4 CombiM device. The agreement between PaCO2 and PtcCO2 was assessed using the Bland-Altman method.ResultsSixty-seven spontaneously breathing patients were prospectively included (mean age 70 years, 52% men) and 64 first measurements of PtcCO2 (out of 67) were analysed out of the 97 performed. Nineteen patients (28%) had pneumonia, 19 (28%) had acute heart failure and 19 (28%) had an exacerbation of chronic obstructive pulmonary disease. Mean PaCO2 was 49 mm Hg (range 22-103). The mean difference between PaCO2 and PtcCO2 was 9 mm Hg (range -47 to +54) with 95% limits of agreement of -21.8 mm Hg and 39.7 mm Hg. Only 36.3% of the measurement differences were within 5 mm Hg.ConclusionsOur results show that PtcCO2 measured by the TCM4 device could not replace PaCO2 obtained by arterial blood gas analysis.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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