Comparison of mainstream end tidal carbon dioxide on Y-piece side versus patient side of heat and moisture exchanger filters in critically ill adult patients: a prospective observational study

The purpose of the study was to investigate the accuracy of mainstream EtCO(2) measurements on the Y-piece (filtered) side of the heat and moisture exchanger filter (HMEF) in adult critically ill patients, compared to that on the patient (unfiltered) side of HMEF. We conducted a prospective observational method comparison study between July 2019 and December 2019. Critically ill adult patients receiving mechanical ventilation with HMEF were included. We performed a noninferiority comparison of the accuracy of EtCO(2) measurements on the two sides of HMEF. The accuracy was measured by the absolute difference between PaCO(2) and EtCO(2). We set the non-inferiority margin at + 1 mmHg in accuracy difference between the two sides of HMEF. We also assessed the agreement between PaCO(2) and EtCO(2) using Bland–Altman analysis. Among thirty-seven patients, the accuracy difference was − 0.14 mmHg (two-sided 90% CI − 0.58 to 0.29), and the upper limit of the CI did not exceed the predefined margin of + 1 mmHg, establishing non-inferiority of EtCO(2) on the Y-piece side of HMEF (P for non-inferiority < 0.001). In the Bland–Altman analyses, 95% limits of agreement between PaCO(2) and EtCO(2) were similar on both sides of HMEF (Y-piece side, − 8.67 to + 10.65 mmHg; patient side, − 8.93 to + 10.67 mmHg). The accuracy of mainstream EtCO(2) measurements on the Y-piece side of HMEF was noninferior to that on the patient side in critically ill adults. Mechanically ventilated adult patients could be accurately monitored with mainstream EtCO(2) on the Y-piece side of the HMEF unless their tidal volume was extremely low. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10877-022-00901-6.