![]() ![]() Transcutaneous CO 2 (tcP CO2) was measured using the SenTec Digital Monitoring System (SDMS) manufactured by SenTec AG (Therwil, Switzerland ). Based on preliminary data in neonates, our null hypothesis was that there would be no difference between venous CO 2 as measured by end-tidal and transcutaneous methods.Įnd-tidal CO 2 (Et CO2) was measured via the sidestream (diverting) sampling device (Medline 3m 0.06 ID) on the anesthesia machine (GE Aisys Datex-Ohmeda). Adequate direct comparisons of the two monitors are not available. Many neonatal intensive care units and pediatric intensive care units (PICU) utilize tcP CO2 as a primary means of Pa CO2 monitoring. In addition, Et CO2 is not feasible in high-frequency oscillators or jet ventilators as the volume of each breath is less than dead space. The sampling flow rate on the Et CO2 in relation to the tidal volume and total flow used to ventilate extremely low birth weight infants provides ambiguous data. While this methodology is well established in operative care, Et CO2 is known to be less accurate in the neonatal population. The standard of care for monitoring respiratory status during anesthesia has been end-tidal CO 2 (Et CO2) and pulse oximetry. 7 This non-invasive infant study uses Pv CO2 as the surrogate for Pa CO2. 4, 5 One study which showed close correlation of Et CO2 with Pa CO2 recommends Et CO2 usage for longitudinal monitoring in the neonatal intensive care unit (NICU) 6 data from a more heterogeneous intraoperative cohort suggest that tcP CO2 may be more accurate. ![]() Two recent reviews suggest that tcP CO2 should be used as an adjunct to end-tidal CO 2. Publications relating to use in infants and children with respiratory failure, 1 congenital heart disease, 2 and one lung ventilation 3 have demonstrated improved correlation between Pa CO2 with tcP CO2 as compared to correlation of Pa CO2 with Et CO2 however, controversy exists. ![]() Recent literature has evaluated the relative efficacy of transcutaneous CO 2 (tcP CO2) compared to end-tidal CO 2 (Et CO2) monitoring as a reflection of arterial CO 2 (Pa CO2). Transcutaneous CO 2 monitoring (tcP CO2) is a well-described non-invasive method to trend ventilation in neonates and is validated as accurate through all age groups. We, therefore, conclude that tcP CO2 is a more accurate measure of operative Pv CO2 in infants, especially in NICU patients. TcP CO2 closely approximates venous blood gas values, in both the NICU and non-NICU samples. Although both measures obtained simultaneously in the same patients agreed moderately with each other (r =0.444, 18 df, P=0.05), Bland–Altman plots indicated that the mean difference (bias) in Et CO2 measurements differed significantly from zero ( P<0.05).Ĭonclusions: Et CO2 underestimates Pv CO2 values in neonates and infants under general anesthesia. ![]() Delta tcP CO2 was close to zero in both groups. Relative to the Pv CO2, the Delta Et CO2 was much greater in the NICU compared to the non-NICU patients (−28.1 versus −9.8, t=3.912, 18 df, P=0.001). NICU (n=6) and non-NICU (n=14) patients did not differ in Pv CO2. Results: Median age was 10.9 weeks, and median weight was 4.4 kg. The mean differences in the NICU and non-NICU patients were compared by t-tests and Bland–Altman analysis. We calculated a mean difference of Et CO2 minus Pv CO2 (Delta Et CO2), and tcP CO2 minus Pv CO2 (Delta tcP CO2) from end-of-case measurements. Venous blood gas (Pv CO2) samples were drawn at the end of the anesthetic. P CO2 was monitored with Et CO2 and with tcP CO2. Methods: After IRB approval and parental written informed consent, we enrolled neonates and infants weighing less than 10 kg, who were scheduled for elective surgery with endotracheal tube under general anesthesia. This study aimed to compare perioperative Et CO2 to tcP CO2 in the pediatric perioperative population specifically below 10 kg, which encompasses neonates and some infants. Many neonatal intensive care units (NICU) have converted to utilizing transcutaneous CO 2 (tcP CO2) monitoring. It is known to be less accurate in the infant population than in adults. Aim: End-tidal CO 2 (Et CO2) is the standard in operative care along with pulse oximetry for ventilation assessment. ![]()
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