Comparison between mainstream (Capnostat 5) and a low-flow sidestream capnometer (Capnostream) in mechanically ventilated, sevoflurane-anesthetized rabbits using a Bain coaxial delivery system

Abstract

Objective: To evaluate agreement between end-tidal carbon dioxide (Pe'CO₂) and PaCO₂ with sidestream and mainstream capnometers in mechanically ventilated anesthetized rabbits, with two ventilatory strategies.

Study design: Prospective experimental study.

Animals: A total of 10 New Zealand White rabbits weighing 3.6 ± 0.3 kg (mean ± standard deviation).

Methods: Rabbits anesthetized with sevoflurane were intubated with an uncuffed endotracheal tube (3.0 mm internal diameter) and adequate seal. For Pe'CO₂, the sidestream capnometer sampling adapter or the mainstream capnometer was placed between the endotracheal tube and Bain breathing system (1.5 L minute^-1 oxygen). PaCO₂ was obtained from arterial blood collected every 5 minutes. A time-cycled ventilator delivered an inspiratory time of 1 second and 12 or 20 breaths minute^-1. Peak inspiratory pressure was initially set to achieve Pe'CO₂ normocapnia of 35-45 mmHg (4.6-6.0 kPa). A total of five paired Pe'CO₂ and PaCO₂ measurements were obtained with each ventilation mode for each capnometer. Anesthetic episodes were separated by 7 days. Agreement was assessed using Bland-Altman analysis and linear mixed models; p < 0.05.

Results: There were 90 and 83 pairs for the mainstream and sidestream capnometers, respectively. The mainstream capnometer underestimated PaCO₂ by 12.6 ± 2.9 mmHg (proportional bias 0.44 ± 0.06 mmHg per 1 mmHg PaCO₂ increase). With the sidestream capnometer, ventilation mode had a significant effect on Pe'CO₂. At 12 breaths minute^-1, Pe'CO₂ underestimated PaCO₂ by 23.9 ± 8.2 mmHg (proportional bias: 0.81 ± 0.18 mmHg per 1 mmHg PaCO₂ increase). At 20 breaths minute^-1, Pe'CO₂ underestimated PaCO₂ by 38.8 ± 5.0 mmHg (proportional bias 1.13 ± 0.10 mmHg per 1 mmHg PaCO₂ increase).

Conclusions and clinical relevance: Both capnometers underestimated PaCO₂. The sidestream capnometer underestimated PaCO₂ more than the mainstream capnometer, and was affected by ventilation mode.

Keywords: arterial partial pressure carbon dioxide; capnography; end-tidal carbon dioxide; lagomorph; mechanical ventilation.