Accuracy and Interpretation of Transcutaneous Carbon Dioxide Monitoring in Critically Ill Children.

Autor:	Setar L; Ann and Robert H. Lurie Children's Hospital, Chicago, IL.; Division of Pediatrics, Northwestern McGaw Medical Center, Chicago, IL., Lee JG; Ann and Robert H. Lurie Children's Hospital, Chicago, IL.; Division of Pediatrics, Northwestern McGaw Medical Center, Chicago, IL., Sanchez-Pinto LN; Ann and Robert H. Lurie Children's Hospital, Chicago, IL.; Division of Pediatrics, Northwestern McGaw Medical Center, Chicago, IL., Coates BM; Ann and Robert H. Lurie Children's Hospital, Chicago, IL.; Division of Pediatrics, Northwestern McGaw Medical Center, Chicago, IL.
Jazyk:	angličtina
Zdroj:	Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2024 Sep 01; Vol. 25 (9), pp. e372-e379. Date of Electronic Publication: 2024 Jun 27.
DOI:	10.1097/PCC.0000000000003564
Abstrakt:	Objectives: Transcutaneous carbon dioxide (Tc co2 ) monitoring can noninvasively assess ventilation by estimating carbon dioxide ( CO2 ) levels in the blood. We aimed to evaluate the accuracy of Tc co2 monitoring in critically ill children by comparing it to the partial pressure of arterial carbon dioxide (Pa co2 ). In addition, we sought to determine the variation between Tc co2 and Pa co2 acceptable to clinicians to modify patient care and to determine which patient-level factors may affect the accuracy of Tc co2 measurements. Design: Retrospective observational cohort study. Setting: Single, quaternary care PICU from July 1, 2012, to August 1, 2020. Patients: Included participants were admitted to the PICU and received noninvasive ventilation support (i.e., continuous or bilevel positive airway pressure), conventional mechanical ventilation, or high-frequency oscillatory or percussive ventilation with Tc co2 measurements obtained within 15 minutes of Pa co2 measurement. Interventions: None. Measurements and Main Results: Three thousand four hundred seven paired arterial blood gas and Tc co2 measurements were obtained from 264 patients. Bland-Altman analysis revealed a bias of -4.4 mm Hg (95% CI, -27 to 18.3 mm Hg) for Tc co2 levels against Pa co2 levels on the first measurement pair for each patient, which fell within the acceptable range of ±5 mm Hg stated by surveyed clinicians, albeit with wide limits of agreement. The sensitivity and specificity of Tc co2 to diagnose hypercarbia were 93% and 71%, respectively. Vasoactive-Infusion Score (VIS), age, and self-identified Black/African American race confounded the relationship between Tc co2 with Pa co2 but percent fluid overload, weight-for-age, probe location, and severity of illness were not significantly associated with Tc co2 accuracy. Conclusions: Tc co2 monitoring may be a useful adjunct to monitor ventilation in children with respiratory failure, but providers must be aware of the limitations to its accuracy. Competing Interests: Dr. Coates received support for article research from The Doris Duke Foundation and The American Lung Association. Dr. Coates’ institution received funding from the Walder Foundation, the Doris Duke Foundation, the National Heart, Lung, and Blood Institute (R01 HL168672), and the American Lung Association; she received funding from Sobi, Triplett Woolf Garretson, LLC, and the Centers for Disease Control and Prevention; and she received support for article research from the Walder Foundation and the Doris Duke Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)
Databáze:	MEDLINE
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