Transcutaneous Carbon Dioxide Pressure (tcPCO2) Monitoring for the Prediction of Extubation Failure in the ICU

Is Transcutaneous Carbon Dioxide Pressure (tcPCO2) Monitoring During Spontaneous Breathing Trials Useful to Predict Extubation Failure in Mechanically Ventilated Patients in the ICU?

Difficult weaning from ventilation and extubation failure are major issues in intensive care, concerning 30% and 12% of patients respectively. These can be partly explained by the lack of accuracy of spontaneous breathing trial (SBT) failure criteria to predict extubation failure. The investigators performed a pilot study to evaluate transcutaneous carbon dioxide pressure (tcPCO2) monitoring during SBTs. The results showed that the difference between maximum and initial tcPCO2 (or ΔtcPCO2) was significantly higher in the group of patients who failed SBTs according to the usual criteria. Moreover, the results suggested that ΔtcPCO2 could be an accurate and early criterion for SBT failure. The size of the study could not examine ΔtcPCO2 regarding extubation failure. Therefore, the main objective of this study is to determine if Δ tcPCO2 during SBTs is associated with extubation failure.

Inclusion Criteria:

• > 18 years old,
• ICU indicated
• invasive mechanical ventilation via orotracheal or nasotracheal intubation
• presence of criteria for initiation of the weaning process as stated on our ICU's protocol
• resolution of the disease leading to mechanical ventilation

Exclusion Criteria:

• mechanical ventilation during less than 24 hours

• Tracheotomy and tracheostomy at ICU admission

• Pregnancy

• Patient under legal protection

  • Patient enrolled in another study regarding weaning or CO2 metabolism