Transcutaneous and End-Tidal CO 2 Measurements in Hypoxia and Hyperoxia
BACKGROUND: Transcutaneous measurement of carbon dioxide (CO 2 ) has been proposed for physiological monitoring of tactical jet aircrew because in some clinical settings it mirrors arterial CO 2 partial pressure (P a co 2 ). End-tidal monitoring in laboratory settings is known to give high-fidelity estimates of P a co 2 . METHODS: The correspondence between end-tidal (P ET co 2 ) and transcutaneous Pco 2 (tcPco 2 ) was examined in healthy volunteers under laboratory conditions of hyperoxia and hypoxia. Rest and exercise, skin heating and cooling, hyperventilation, and induced CO 2 retention were employed. RESULTS: Neither measure followed all known changes in P a co 2 and tcPco 2 changed when the skin temperature near the probe changed. Bland-Altman analysis showed significant nonzero slopes under most conditions. Regression analysis indicated that oxygen partial pressure (Po 2 ) in tissue measured as transcutaneous Po 2 (tcPo 2 ) is an important explanatory variable for tcPco 2 in addition to P ET co 2 , and that local skin temperature also has an effect. Additionally, absorption atelectasis from breathing 100% O 2 may cause P ET co 2 to deviate from P a co 2 . DISCUSSION: Even as a trend indicator for P a co 2 , tcPco 2 is not useful under conditions that resemble those in the highly dynamic tactical jet aircraft environment. P ET co 2 is also not a good indicator of CO 2 status in pilots who breathe nearly 100% O 2 . Shykoff BE, Lee LR, Gallo M, Griswold CA. Transcutaneous and end-tidal CO 2 measurements in hypoxia and hyperoxia . Aerosp Med Hum Perform. 2021; 92(11):864–872 .