Patient with Sleep Apnea, Lung Carsinoma, and Obesity: Capnostream Monitorisation in Hypercapnea

Ertay Boran ¹, Mertay Boran ²

¹ Department of Anesthesiology and Reanimation, Duzce University Faculty of Medicine, Duzce, Turkey; ² Department of Thoracic Surgery, Duzce University Faculty of Medicine, Duzce, Turkey;

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – B

Abstract

Background: Sleep apnea, obesity and grade 4 lung carcinoma are clinical stations characterized with CO2 deposition. Capnostream and nose-mouth mask canıma are suitable for end-tidal CO2 monitorisation in spontaneous breathing patient and deliver rapid solutions.

Case: 50 year old patient sent to emergency clinic with difficulty in breathing and sleepy mood.There was seen that patient has massive pleural effusion in left hemithorax, after thoracentesis hypercapnia and hypoxemia was seen and patient was intubated and thereafter was transferler and accepted to our ICU clinic.. Hypertension, DM, obesity, and, sleep apnea were the comorbid diseases of the patient. In 24 hour period of the intubated patient there was found that the left hemithorax was obliterated with lung carcinoma.The patient was extubated and breathing physiotherapy( couphing, baloon egsersises) and NIV was applied.

The patient was diagnosed with chronic hypercapnia and the arterial PCO2 parameter differentiate between 50-80 mmHg levels. In simultane time the end CO2 parameters was measured with nose-mouth cannula and capnostream. We saw that in minimum hypercapnia level of the patient( <50 mmhg) there was consistency between the two parameters and in high level of hypercapnia (60 mmhg) big difference existed between the parameters.In clinical visits we saw that the patient develop the sleepy mood in CO2 levels >75 mg Hg.

Conclusion: The monitoriation of hypercapnia and breathing insufficiency with capnostream can not be used safely. In our patient we prefer to use arterial CO2, clinic and consciousness level for the monitoriastion of high CO2 levels.