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Amy Goodchild istockphoto

TRANSCUTANEOUS CARBON DIOXIDE AND OXYGEN MONITORING IN THE ADULT PATIENT

R. Carter
Correspondence R. Carter Dept of Respiratory Medicine Royal Infirmary Glasgow G31 2ER UK E-mail: roger.carter@northglasgow.scot.nhs.uk

Transcutaneous technology for the noninvasive monitoring of oxygen and carbon dioxide has been used for about 40 years. The covered polarographic blood gas electrode for oxygen was modified for transcutaneous use by EVANS and NAYLOR [1] in 1967. This electrode did not heat the underying skin and therefore measured the oxygen level at normal skin surface temperature. Their work showed that the level of oxygen diffusing from the dermal capillaries to the skin surface is mainly governed by skin blood flow and temperature. This led to the development of transcutaneous electrodes which incorporated a thermostatically controlled heating element to maximise local blood flow. A good relationship between transcutaneous oxygen tension

(Ptc,O2) and arterial oxygen tension (Pa,O2) was demonstrated in neonates and this led to the use of continuous noninvasive Ptc,O2 monitoring in neonatal intensive care units [2]. It was initially believed that Ptc,O2 measurements would not be satisfactory in adults due to their thicker epidermis, but subsequent studies have shown that this technology may work just as well for older children and adults [3, 4]. The transcutaneous electrode for the assessment of carbon dioxide consists of a Stow Severinghaus glass electrochemical sensor that has been modified for transcutaneous use by the incorporation of a thermostatically controlled heater unit as in the Ptc,O2 electrode [5]. Close correlations between

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transcutaneous carbon dioxide tension (Ptc,CO2) and arterial carbon dioxide tension (Pa,CO2) have again been demonstrated in adults as well as in neonates [6, 7]. Transcutaneous measurements of oxygen and carbon dioxide are based on the principle that a heating element in the electrode elevates the temperature of the underlying tissues. This increases the capillary blood flow and the partial pressure of oxygen and carbon dioxide, and makes the skin permeable to gas diffusion (fig. 1). It must be remembered that the electrode is measuring the gas tensions of the underlying tissue and not the arterial gas tension. When haemodynamic conditions are stable, the transcutaneous measurements correlate well with arterial values but are not identical. The actual level of transcutaneous oxygen reflects the relationship between the increase in partial pressure in the capillary blood due to heating, the level of skin blood flow and the metabolic oxygen consumption of the skin. In spite of these physiological factors, when blood flow is normal, transcutaneous oxygen values can reliably reflect arterial values. In the case of Ptc,CO2, the elevated temperature at which the transcutaneous electrode operates in order to increase skin permeability will also raise skin metabolism and lead to an increase in CO2 production. The measured values will, therefore, be significantly higher than arterial values at 37oC. The transcutaneous values can be temperature corrected, thus enabling a readout of values comparable to those at the normal body temperature. These will deviate by a small metabolic contribution from the carbon dioxide production in the epidermis. Transcutaneous monitoring of carbon dioxide tension (PCO2) has been shown to be more reliable than the transcutaneous measurement of oxygen due to the greater diffusion capacity of carbon dioxide through the skin.

Figure 1. A transcutaneous gas tension measurement electrode.

The more recent development in transcutaneous technology has been the introduction of a solid-state combined Ptc, O2/Ptc, CO2 electrode with the glass section of the Ptc, CO2 electrode being strengthened by incorporation of ceramic material, making it much more robust and less liable to damage [8].

Calibration methods The polarographic method of measuring transcutaneous oxygen requires only a two-point calibration procedure as the signal output from a Clark cell is virtually linear over the physiological range. For the lower point calibration, an electrical zero will suffice, being equivalent to zero PCO2. The conventional calibration of the upper point usually uses a dry gas of suitable composition or room air. Calibration in this manner generally leads to underestimation of P,O2 compared with arterial values. For the transcutaneous carbon dioxide electrode, the standard method of calibration involves the use of two known gas mixtures, commonly 5 and 10% CO2. This method of calibration produces results that exceed the true arterial Pa, CO2 by an amount largely determined by electrode

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temperature. Due to the potential errors that can arise from the gas calibration method, it is also possible to calibrate the transcutaneous oxygen and carbon dioxide upper points by using the independently measured Pa,O2 and Pa,CO2 in the subjects own arterial or arterialised ear lobe capillary blood sample. With this method, the electrode is attached to the skin and a stable provisional Ptc,O2 and Ptc,CO2 are obtained. This warm-up period is one disadvantage of transcutaneous monitoring as it can take some time (usually 1020 min) for the electrode to reach its optimal working conditions. An arterial sample or arterialised ear lobe capillary sample is obtained and the Ptc,O2 and Ptc,CO2 signal gains can then be adjusted to the values obtained from the directly measured blood sample. This in vivo method of calibration has the advantage that all of the unpredictable skin factors contributing to the differences between transcutaneous and arterial values remain relatively constant, provided that a constant temperature and heat field can be established in the skin. The two calibration methods have been compared in several studies and have shown that the transcutaneous values can provide a more accurate estimation of true arterial values if the in vivo calibration method is used [9, 10]. In the intensive care unit, this method offers no additional problems if an arterial cannula is already in situ. This is generally not the case in patients undergoing physiological testing and it might be suggested that arterial or ear lobe capillary sampling is unjustified in these circumstances, however properly performed, a single arterial stab or ear lobe capillary sampling can be a troublefree procedure.

rapid and equilibrium is usually obtained within 30 s. Previously, Ptc,CO2 electrodes were slower to respond than Ptc,O2 electrodes but with current systems their response time is almost as fast. Modern electrodes are therefore capable of responding faithfully to virtually any physiological change that is likely to occur. In contrast, the in vivo response times depend on many physiological variables that are not necessarily constant. The 90% response time for a change in normal subjects from normoxic to hypoxic conditions has been shown to be ~40 s for Ptc,O2 and ~60 s for Ptc,CO2 at the highest electrode temperature of 45oC [10]. The in vivo response time increases with reducing electrode temperature [11].

Site selection The absolute value of Ptc,O2 is affected by skin thickness and capillary density. It is therefore important to place the electrode at a site of high capillary density and minimal thickness for optimal transcutaneous measurements. This presents no problem in the newborn, in whom these conditions are usually fulfilled. In adults, there is greater variation from site to site and the suggested locations for optimal transcutaneous measurements are the forearm, chest or abdomen.

Sp,O2 measurement) and a heating element (to increase local perfusion). The small size of the sensor allows convenient placement on the earlobe. Calibration of the Ptc,CO2 sensor is the same as above. This sensor has been shown to accurately reflect directly measured Pa,CO2 and arterial oxygen saturation (Sa,O2) in adults and children undergoing general anaesthesia, to reflect ventilation and oxygenation [12, 13]. In addition, this combined sensor has been shown to accurately monitor Sa,O2 and Pa,CO2 in critically ill patients and patients with sleep apnoea using an electrode temperature of 42oC [14]. The authors suggested that owing to its ability to assess both ventilation and oxygenation noninvasively, in addition to pulse rate by a single transcutaneous sensor, this technique is a convenient and valuable tool for respiratory monitoring with potential applications in critical care, anaesthesia and sleep medicine. This sensor has also been validated in the care of neonates [15, 16].

Applications Peripheral vascular disease In patients with peripheral vascular disease, transcutaneous oxygen provides a useful supplement when evaluating the severity of the illness. Impairment of blood flow in the region next to the electrode may lead to a considerable underestimate of the true Pa,O2. This property has been utilised in the assessment of local blood flow and in studies of lower limb ischaemia. Ischaemia caused by peripheral vascular disease accounts for the majority of lower limb amputations. Although the standard practice is to assess limb perfusion through physical examination and clinical judgement, the development of quantitative measurements of perfusion is important as perfusion determines the degree and progression of the pathological

Combined Ptc,CO2 and pulse oximetry In adults, as mentioned previously, the transcutaneous partial pressure of oxygen depends heavily on local skin perfusion and may not reliably reflect true Pa,O2 unless an in vivo calibration has been performed. This has led to the development of a combined sensor for the measurement of both transcutaneous CO2 and pulse oximetric saturation (Sp,O2) rather than Ptc,O2. This electrode contains an electrochemical electrode (for Ptc,CO2), a light emitter/sensor (for

Response time The response time to a square wave change in PO2 in the gas phase is

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process that can lead to amputation. In order to establish the ideal amputation level, a perfusion-based methodology that can accurately determine the boundaries between those tissues that cannot potentially heal and those that can heal uneventfully would be an advantage. As local blood flow is known to be a limiting factor in achieving equilibrium between Pa,O2 and Ptc,O2, this phenomenon may be used to estimate the local perfusion deficit by measuring the Ptc,O2 reached after enhancing blood flow by local heating with a series of transcutaneous electrodes in different leg positions [17]. This procedure often makes it possible to predict whether amputation is needed. A reference level of 2.66 kPa (20 mmHg) has been suggested as being suitable for evaluation of the amputation level [18]. In both venous and arterial diseases, Ptc,O2 can be used to evaluate the effect of therapeutic interventions [19]. Cardiopulmonary exercise testing Accurate and reliable measurements of gas exchange are imperative during cardiopulmonary exercise testing. The slow response characteristics of the combined transcutaneous electrode have been viewed as a major disadvantage when compared with other types of noninvasive assessment of gas exchange during exercise testing. It has been shown however that the in vivo calibration method is able to produce a close agreement between Ptc,O2 and Pa,O2 at all stages of an exercise test in both patients and normal subjects. The use of the highest electrode temperature and subsequent increase in response time makes it possible to monitor any physiological changes in blood gases that occur [4, 10]. There was no morbidity associated with the use of the transcutaneous electrode heated to 45 oC. It has also been shown that using a gradual incremental exercise protocol (2-min increments), to allow for the latency in the response time of the system, it is possible to derive accurate

parameters of gas exchange (alveolararterial oxygen gradient and dead space/tidal volume ratio) during exercise testing [20]. This technique allows the assessment of the contribution of ventilation/perfusion inequality to breathlessness on exertion in patients, provided an in vivo calibration is performed. The technique is particularly valuable in patients undergoing repeat exercise tests as it circumvents the need for arterial cannulation. The use of transcutaneous monitoring to assess gas exchange during exercise has been used in a number of patient groups, including those with cardiac failure being assessed for or followed up after cardiac transplantation [2123]. Sleep disorders Many neuromuscular and cardiorespiratory disorders are complicated by sleep disturbances. Apnoeas and sudden desaturations with hypoxia are a feature of patients with sleep apnoea, but the response of the transcutaneous oxygen electrode is too slow to accurately assess the number of hypoxic dips and in this case pulse oximetry is usually the first choice of assessment [24]. When using pulse oximetry, the use of an appropriate signal-averaging time is important since, once again, the use of too long an averaging time will significantly underestimate the number of hypoxic dips [25]. Continuous monitoring of Ptc,CO2 during sleep may be considered if nocturnal CO2 retention is to be documented. Transcutaneous monitoring of PCO2 has been a useful measurement in patients with respiratory failure due to COPD [26, 27]. The main problem with the use of transcutaneous monitoring is the need to change the site of the electrode to prevent thermal skin trauma if an electrode temperature >43oC is employed. It is possible to obtain effective Ptc,CO2 at lower temperatures (42oC) giving a site time of up to 8 h. The development of the combined Ptc,CO2/Sp,O2 using an electrode

temperature of 42oC, which does not adversely affect the accuracy or dynamic response characteristics of the pulse oximeter [14], has the potential to assess both ventilation in terms of transcutaneous CO2 and rapid fluctuations in Sp,O2 in patients with sleep-disordered breathing. Respiratory support Noninvasive ventilation Domiciliary noninvasive ventilation (NIV) and tracheotomy-mediated mechanical ventilation are effective procedures for managing severe hypercapnic chronic respiratory disease. It is recommended that assessing diurnal gas exchange is essential in order to confirm the efficacy of ventilation at initiation and during follow-up. In most cases the daytime blood gases will be abnormal with an elevated Pa,CO2 and low Pa,O2 but in some symptomatic patients the daytime blood gases may be normal. Overnight studies frequently reveal far greater abnormality as respiratory impedance rises and ventilator drive falls during sleep. Noninvasive arterial oxygenation is routinely and satisfactorily monitored with transcutaneous pulse oximeters. Noninvasive Pa,CO2 monitoring, however, is more complex and still requires serial arterial blood sampling. NIV is a leak ventilation; end-tidal CO2 measurements are subject to large variability resulting in a reduction in the correlation with Pa,CO2. Interest has centred on the measurement of Ptc,CO2 if rapid tracking of transient fluctuations of Pa,CO2 is not essential. The use of the combined Ptc,CO2/Sp,O2 sensor has been validated against measurements on arterial blood gas samples repeatedly drawn from indwelling arterial lines [14] and been shown to accurately monitor directly measured Pa,CO2 and Sa,O2, and their changes in critically ill adult patients [28]. This technology has been shown to be useful in the initiation of noninvasive ventilation and titrating of ventilator settings for

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the treatment of chronic respiratory failure [29] as some of these patients are sensitive to supplemental oxygen and readily become hypercapnic if not monitored appropriately. Overnight studies to assess for NIV are also particularly important in those patients with chest wall or neuromuscular disease [30]. If NIV is to be introduced during an acute episode of ventilator failure, continuous monitoring of Ptc,CO2 to allow timely decision making is even more important. To determine whether the treatment is working it is necessary to record the CO2. Arterial measurements cannot be made continuously, and if additional oxygen is used this will invalidate Sp,O2 as a surrogate measure of ventilation. If the Ptc,CO2 does not fall with NIV, the patient may require intubation and ventilation. Weaning from invasive ventilation

level which is symptomatic or which may be considered to put the patient at risk of rapid deterioration when they are given additional oxygen. It has been suggested that continuous noninvasive monitoring of Sp,O2 and Ptc,CO2 during the titration may help to identify the optimum flow rate at which point formal assessment of arterial blood gases can be performed to ensure that the hypoxia has been corrected and that hypercapnia has not been induced. The use of transcutaneous monitoring during the titration reduces the number of arterial or arterialised ear lobe capillary samples that need to be obtained. It may also be possible to repeat this process during sleep, when ventilation is at its most vulnerable. If in this case the transcutaneous Ptc,CO2 is further elevated, then NIV may be a more appropriate treatment. Adult anaesthesia

Whenever changes are made to ventilator support it is important to measure the effect on arterial blood gases. This is especially important during weaning, when ventilator support is being reduced. Using continuous noninvasive measurements of Ptc,CO2 and Sp,O2 will be less disturbing to the patient than repeated arterial stabs or sampling from indwelling lines. At the time of extubation changes in blood chemistry may occur quickly and the noninvasive monitoring with Sp,O2 and Ptc,CO2 will give an early indication if the patients own ventilator effort is inadequate. Continuous monitoring of these variables may also suggest that the initiation of NIV may need to be considered. Titrating long-term oxygen therapy Long-term oxygen therapy (LTOT) is most frequently prescribed for patients with COPD. Once a patient has been identified as likely to benefit from LTOT, the oxygen levels are titrated up to a maximum flow rate which corrects the hypoxia but without worsening hypercapnia to a

During general anaesthesia, postoperative recovery and critical care treatment, the monitoring of oxygenation and ventilation are important. As pulse oximetry only estimates arterial oxygen saturation, periodic blood sampling would still be necessary to fully determine the patients ventilation status by the measurement of Pa,CO2. It has been shown that during general anaesthesia [31], a combined Ptc,CO2/Sp,O2 ear sensor, produced transcutaneous values of CO2 which did not differ significantly from directly measure Pa,CO2. The authors suggested that the combined sensor proved to be a reliable tool for continuous noninvasive monitoring of oxygenation and ventilation. Overall, the range of devices for transcutaneous assessment of oxygen and carbon dioxide have been shown to give a reliable indication of arterial levels especially if an in vivo calibration is performed. They are able to provide a continuous noninvasive assessment of oxygenation and ventilation in a number of clinical situations.

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REFERENCES
1. Evans NTS, Naylor PFD. The systemic oxygen supply to the surface of human skin. Respir Physiol 1967: 3: 2137. 2. Huch R, Huch A, Albani M, et al. Transcutaneous PO2 monitoring in routine management of infants and children with cardiorespiratory problems. Pediatrics 1976; 57: 681690. 3. Hutchison DCS, Rocca G, Honeybourne D. Estimation of arterial oxygen tension in adult subjects using transcutaneous electrode. Thorax 1981; 36: 473477. 4. Hughes JA, Gray BJ, Hutchison DCS. Changes in transcutaneous oxygen tension during exercise in pulmonary emphysema. Thorax 1984; 39: 424431. 5. Severinghaus JW, Stafford M, Bradley AF. TcPCO2 electrode design, calibration and temperature gradient problems. Acta Anaesthesiol Scand Suppl 1978; 68: 118122. 6. Goldman MD, Gribbin HR, Martin RJ, Transcutaneous pCO2 in adults. Anaesthesia 1982; 37: 944946. 7. Binder N, Atherton H, Thorkelsson T, Hoath SB. Measurement of transcutaneous carbon dioxide in infants during the first two weeks of life. Am J Perinatol 1994; 11: 237241. 8. Larsen J, Linnet N, Vesterger P. Transcutaneous devices for the measurement of PO2 and PCO2. State of the art, especially emphasizing a PCO2 sensor based on a solid state gas pH sensor. Am Biol Clin (Paris) 1993, 50: 899902. 9. Gray BJ, Heaton RW, Henderson A, Hutchison DCS. In vivo calibration of a transcutaneous oxygen electrode in adult patients. Adv Exp Med Biol 1987; 200: 7577. 10. Sridhar MK, Carter R, Moran F, Banham SW. Use of a combined oxygen and carbon dioxide transcutaneous electrode in the estimation of gas exchange during exercise. Thorax 1993; 48: 643647. 11. Nishiyama T, Nakamura S, Yamashita K. The effects of the electrode temperature of a new monitor, TCM4, on the measurement of transcutaneous oxygen and carbon dioxide tension. J Anesth 2006; 20: 331334. 12. Eberhard P, Gisiger PA, Gardaz JP, Spahn DR. Combining transcutaneous blood gas measurement and pulse oximetry. Anesth Analg 2002; 94: S86S80. 13. Dullenkopf A, Bernardo S, Berger F, Fasnacht M, Gerber AC, Weiss M. Evaluation of a new combined SpO2/PtcCO2 sensor in anaesthetised paediatric patients. Paediatr Anaesth 2003; 13: 18. 14. Senn O, Clarenbach CF, Kaplan V, Maggiorini M, Bloch KE. Monitoring carbon dioxide tension and arterial oxygen saturation by a single earlobe sensor in patients with critical illness or sleep apnea. Chest 2005; 128: 12911296. 15. Bernet-Buettiker V, Ugarte MJ, Frey B, Hug MI, Baenziger O, Weiss M. Evaluation of a new combined transcutaneous measurement of PCO2/pulse oximetry oxygen saturation ear sensor in newborn patients. Pediatrics 2005; 115: 6468. 16. Parker SM, Gibson GJ. Evaluation of a transcutaneous carbon dioxide monitor (TOSCA) in adult patients in routine practice. Respir Med 2007; 101: 261264. 17. Figoni SF, Scremin OU, Krunkel CF. Pre-amputation evaluation of limb perfusion with laser Doppler imaging and transcutaneous gases. JRRD 2006; 43:891904. 18. Misuri A, Lucertini G, Nanni A, Viacava A, Belardi P. Predictive value of transcutaneous oximetry for selection of the amputation level. J Cardiovasc Surg 2000; 41: 8387. 19. Melillo E, Nuti M, Pedrinelli R, Buttitta F, Balbarini A. Is transcutaneous oxygen and carbon dioxide monitoring indispensible in short and long term therapeutic management of non-reconstructable lower critical limb ischaemia? Minerva Cardioangiol 2006; 54: 481498. 20. Carter R, Banham SW. Use of transcutaneous oxygen and carbon dioxide tensions for assessing indices of gas exchange during exercise testing. Respir Med 2000; 94: 350355. 21. Tweddel A, Carter R, Banham SW, Hutton I. Breathlessness in microvascular angina. Respir Med 1994; 88: 731736. 22. Al-Rawas OA, Carter R, Richens D, et al. Ventilatory and gas exchange abnormalities on exercise in chronic heart failure. Eur Respir J 1995; 8: 20222028. 23. Carter R, Al-Rawas OA, Stevenson A, Mcdonagh T, Stevenson RD. Exercise responses following heart transplantation: 5 year follow-up. Scott Med J 2006; 51: 613. 24. Wiltshire N, Kendrick AH, Catterall JR. Comparison of two pulse oximeters for sleep studies in the home and in the laboratory. Eur Respir J 1995; 8: Suppl 19, 149s. 25. Kendrick AH, Wiltshire N, Catterall JR. Effect of signal averaging time (TSA) on on-line pulse oximetry used for overnight sleep recordings. Am J Respir Crit Care Med 1996; 153: A714. 26. Mulloy E, McNicholas WT. Ventilation and gas exchange during sleep and exercise in severe COPD. Chest 1996; 109: 387394. 27. Janssens JP, Howarth-Frey C, Chevrolet JC, Abajo B, Rochat T. Transcutaneous PCO2 to monitor non-invasive mechanical ventilation in adults: assessment of a new transcutaneous PCO2 device Chest 1998; 113: 768773. 28. Bendjelid K, Schutz N, Stotz M, Gerard I, Suter PM, Romand GA. Transcutaneous PCO2 monitoring in critically ill adults. Clinical evaluation of a new sensor. Crit Care Med 2005; 33: 22032206. 29. Cuvelier A, Grigoriu B, Molano LC, Muir J-F. Limitations of transcutaneous carbon monoxide measurements for assessing long term mechanical ventilation. Chest 2005; 127: 17441748. 30. Fauroux B, Lofaso F. Randomised controlled trial of non-invasive ventilation (NIV) for nocturnal hypoventilation in neuromuscular and chest wall disease patients with daytime normocapnia. Thorax 2005; 60: 979980. 31. Rohling R, Biro P. Clinical investigation of a new combined pulse oximetry and carbon dioxide tension sensor in adult anaesthesia. J Clin Monit Comput 1999; 15: 2327.

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Model Company Website Application Electrode(s)

TCM4 Radiometer; Copenhagen www.radiometer.com Neonates to adults Ptc,CO2 pH solid-state glass electrode. Stow-Severinghaus type CO2 electrode. Ptc,O2 25 m platinum. Clark-type O2 electrode. Selectable between 3745C, in steps of 0.5C Windows CE. Touchscreen technology. Normal view (numeric), trend table view, trend curve view Adjustable low and high limits for PO2 and PCO2 Audible and visual alarm indication 0.713.3 0.6 099.9 Range 021%: 0.6 kPa Range 21100%: 10% NA NA NA NA <18 s for PO2 <26 s for PCO2 Pt,O2: 5% over calibration interval Pt,CO2: 10% over calibration interval Auto-calibration. Integrated gas bottle. 1-point, 7.5% CO2 and 20.9% O2, balance N2. 4-h calibration interval recommended Internal 1 h Monitor + Ptc,CO2/Ptc,O2 module 4.58 Monitor: 16 x 30.8 x 23 Ptc,CO2/Ptc,O2 module: 10.7 x 14.5 x 14.8 EIA232 Parallel port IEEE1284, Centronics printer port 48 h of patient data -

TCM40 Radiometer; Copenhagen www.radiometer.com Neonates to adults Ptc,CO2 pH solid-state glass electrode. Stow-Severinghaus type CO2 electrode. Ptc,O2 25 m platinum. Clark-type O2 electrode. Sp,O2 Nellcor Probes. Selectable between 3745C, in steps of 0.5C Windows CE. Touchscreen technology. Normal view (numeric), trend table view, trend curve view Adjustable low and high limits for Sp,O2, PO2 and PCO2. Audible and visual alarm indication 0.713.3 0.6 099.9 Range 021%: 0.6 kPa Range 21100%: 10% 70100 Adults: 3% Neonates: 4% 20250 3 <18 s for PO2 <26 s for PCO2 Pt,O2: 5% over calibration interval Pt,CO2: 10% over calibration interval Auto-calibration. Integrated gas bottle. 1-point, 7.5% CO2 and 20.9% O2, balance N2. 4-h calibration interval recommended Internal 1 h Monitor + Ptc,CO2/Ptc,O2/ Sp,O2 modules 4.78 Monitor: 16 x 30.8 x 23 Ptc,CO2/Ptc,O2 module: 10.7 x 14.5 x 14.8 Sp,O2 module: 3.5 x 14.5 x 14.8 EIA232 Parallel port IEEE1284, Centronics printer port 48 h of patient data -

TCM400 Radiometer; Copenhagen www.radiometer.com Assess cutaneous oxygenation on up to 6 sites Ptc,O2 25 m platinum. Clark-type O2 electrode.

Sensor temperature C Membrane change Screen display

Selectable between 3745C, in steps of 0.5C Windows CE. Touchscreen technology. Normal view (numeric), trend table view, trend curve view Adjustable low and high limits for PO2. Audible and visual alarm indication NA NA 099.9 Range 021%: 0.6 kPa Range 21100%: 10% NA NA NA NA <18 s for PO2 Pt,O2: 5% over calibration interval Auto-calibration

Alarms

Pt,CO2 range kPa Pt,CO2 accuracy kPa Pt,O2 range kPa Pt,O2 accuracy Sp,O2 range % Sp,O2 accuracy Pulse range bpm Pulse accuracy bpm Response time s Drift

Calibration

Battery Weight kg Dimensions (H x W x D) cm

Internal 1 h >4 kg Monitor: 16 x 30.8 x 23

Outputs

Data-logger Software

Data can be printed out in graphical and numerical form Reports can be obtained

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Model Company Website Application Electrode(s)

MicroGas 7650 Rapid Radiometer; Copenhagen www.radiometer.com Noninvasive. Continuous, real time Clark-type PO2 sensor combined with Stow-Severinghaus-type PCO2 sensor Selectable between 3745C, in steps of 0.5C Every 2 weeks 3-digit LED displays for PO2 and PCO2. LCD display, LED back-lit with adjustable contrast, for selectable parameters, messages and alarms

TOSCA 500 Radiometer; Copenhagen www.radiometer.com Noninvasive. Continuous, real time Stow-Severinghaus-type PCO2 combined with Masimo SET Sp,O2 pulse oximetry Recommended: 42C Selectable between 3745C, in steps of 0.5C Every 2 weeks 3-digit LED displays for PCO2, Sp,O2 and pulse rate 10-segment LED bar graph for plethysmogram Graphic LCD with LED back-light and adjustable contrast for selectable parameters, messages and alarms User-selectable display mode for status, trend, plethysmogram and heating power Adjustable low and high limits for PCO2, Sp,O2 and pulse rate Audible and visual alarm indication 025 0.1 NA NA 0100 70100%: 3 digits 2, 4, 8, 10, 12, 14, 16 FastSat 25240 3 <50 s for PCO2 <0.5%h-1 Fully automatic calibration Typical calibration time: 2 min Integrated calibration chamber Internal 1 h 5.3 13.5 x 26.6 x 30 1 x 37-way connector with analogue output, RS 423 1 x 25-way connector with Centronics parallel interface Automatic storage of measured patient data over the previous 72 h Reviewing trends on screen Download to PC Download 2001

SenTec SenTec AG www.sentec.ch Adult and paediatric use Noninvasive. continuous, real time V-Sign combined sensor Pt,CO2/Sp,O2/Pulse 42

Sensor temperature C

Membrane change Screen display

Every 2 weeks TFT Colour Display Trend graphs or numerical data on Pt,CO2, pulse, plethysmograph, Sp,O2

Alarms

Adjustable low and high limits for PO2 and PCO2 Audible and visual alarm indication 0.120 0.099.9 NA NA NA NA NA <25 s for PO2 <60 s for PCO2 <1%h-1 Fully automatic calibration Typical calibration time: 2 min Integrated calibration chamber Internal 1 h 5.6 13.5 x 26.6 x 30 1 x 37-way connector with analogue output, RS 423 and status signals 1 x 25-way connector with Centronics parallel interface Automatic storage of measured patient data over the last 18 h Download to a printer or PC

High/low PCO2, Sp,O2, pulse AC power/battery Status messages

Pt,CO2 range kPa Pt,CO2 resolution kPa Pt,O2 range kPa Pt,O2 accuracy Sp,O2 range % Sp,O2 accuracy Sp,O2 signal averaging s Pulse range bpm Pulse accuracy bpm Response time s Drift Calibration

026.67 0.1 NA NA 1100 70100%: 2% 30250 3 <80 s for PCO2 < 1%h-1 Gas bottle with docking station

Battery Weight kg Dimensions (HxWxD) cm Outputs

Internal 67 h 2.5 10.2 x 27 x 23 Digital: RE/EIA 232 Analogue: 01V

Data-logger

48 h internal memory 240 h external memory

Software

V-STATS

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