Evaluation of a New Combined Transcutaneous Measurement of Pco2/Pulse Oximetry Oxygen Saturation Ear Sensor in Newborn Patients

Abstract

ABSTRACT. Objective. Arterial oxygen saturation (SaO 2 ) and arterial carbon dioxide partial pressure (PaCO 2 ) are 2 of the most important respiratory parameters in the treatment of critically ill neonates. Noninvasive monitoring of these parameters is desirable for continuous estimating of the respiratory status and reducing blood loss because of repeated blood gas analyses. Transcutaneous measurement of PCO 2 (PtcCO 2 ) represents a simple and noninvasive technique for continuous monitoring of ventilation. However, sensor preparation, positioning, taping, and repeated changes of the sensor location make the handling difficult and complicate its use in the neonatal care unit. Recently, a new sensor for combined assessment of pulse oximetry oxygen saturation (SpO 2 ) and PtcCO 2 has been introduced (TOSCA Monitor; Linde Medical Sensors, Basel, Switzerland). The monitor combines pulse oximetry and PtcCO 2 measurement in a single ear sensor, which works at 42°C to enhance blood flow in capillaries below the sensor.Methods. In a prospective, open, nonrandomized study of 60 ill neonates, the new ear sensor for combined assessment of SpO 2 and PtcCO 2 at 42°C was tested. The sensor was adapted to the ear of a neonate with a Varihesive layer (Conva Tec; Princeton, NJ). Data obtained from the ear sensor were compared with SpO 2 Finger/Heel , SaO 2 , and PaCO 2 obtained from arterial blood gas in 30 patients and with a capillary blood gas in an additional 30 patients using Bland Altman bias analysis. Data are presented as median (range).Results. The postconceptional age of the patients was 38.3 weeks (range: 28 5/7-40 5/7) in the arterial group and 37.9 weeks (range: 29 6/7-41 0/7) in the capillary group. Age of the newborns studied was 3.5 days (range: 1-28) in the arterial blood sample group (n ‫؍‬ 30) and 6 days (range: 2-28) in the capillary blood sample group (n ‫؍‬ 30). Patient weight was 3.02 kg (range: 1.5-4.5) in the arterial group and 2.76 kg (range: 1.0 -3.71) in the other group. Three patients had weights of <1500 g. Twentyone of 60 patients were conventionally ventilated, 4 patients received high-frequency oscillation, and 35 were not ventilated. Mean difference (bias) and precision (2 SD of the mean difference) between PtcCO 2 TOSCA and PaCO 2 were ؊0.44 kPa (؊3.21 mm Hg) and 0.82 kPa (6.02 mm Hg) and between PtcCO 2 TOSCA and PcapCO 2 were ؊0.09 kPa (؊0.67 mm Hg) and 1.11 kPa (8.07 mm Hg), respectively. SpO 2 assessment by the TOSCA revealed slightly higher values compared with SaO 2 (bias: ؊0.48%), whereas SpO 2 Finger/Heel values were slightly lower than SaO 2 (bias: 0.52%).Conclusion. The TOSCA monitor with the ear sensor adapted to ears of neonates allows reliable estimation of SaO 2 and PaCO 2 . A potential benefit is the reduction in motion artifacts because of less head movement in newborns and that only a single cable leads form the patient to the monitor. In addition, the sensor is not removed for chest radiograph or for nursing the infant on his or her parent's lap. Long-term studies in a large...

Clinical Validation of a Digital Transcutaneous PCO2/SpO2 Ear Sensor in Adult Patients after Cardiac Surgery

“…In newborns and infants, transcutaneous measurement of carbon dioxide partial pressure (PtcCO 2 ) was introduced 20 years ago [6][7][8] for noninvasive continuous monitoring of ventilation. However, sensor preparation, positioning, taping, and the necessity for repeated changes of the sensorÕs location made handling difficult and complicated its use [9]. More recently, two new devices, the SenTec Digital Monitor V-sign sensor and the TOSCA devise, for combined assessment of PtcCO 2 and SpO 2 using a single ear-clip sensor were introduced [9][10][11][12].…”

“…However, sensor preparation, positioning, taping, and the necessity for repeated changes of the sensorÕs location made handling difficult and complicated its use [9]. More recently, two new devices, the SenTec Digital Monitor V-sign sensor and the TOSCA devise, for combined assessment of PtcCO 2 and SpO 2 using a single ear-clip sensor were introduced [9][10][11][12]. To the best of our knowledge, only three studies assessing the accuracy and reliability of the V-Sign sensor (V-Sign Sensor, SenTec Digital Monitoring System: SenTec AG, Therwil, Switzerland) have so far been published: one in adult volunteers [11], one in patients during bronchoscopy [12], and one in critically ill patients in a medical intensive care unit (ICU) [13].…”

Comparison of Transcutaneous and Capillary Measurement of PCO2in Hypercapnic Subjects

“…The measurement of transcutaneous P CO 2 (P tcCO 2 ) has been examined in critically ill [14][15][16] or ventilated adults 17,18 and newborns, 19 as well as during bronchoscopy 20 or interhospital ground transport. The aim of our study was to compare P tcCO 2 with P capCO 2 in hypercapnic subjects during the night.…”

The Revised Digital Transcutaneous PCO2/SpO2 Ear Sensor Is a Reliable Noninvasive Monitoring Tool in Patients After Cardiac Surgery

“…Initially, PtcCO 2 sensors were mainly utilized in neonatology and in critically ill infants in combination with the measurement of transcutaneous partial oxygen tension [3,4]. Currently, combined assessment of PtcCO 2 and partial oxygen tension using a single earlobe clip sensor is increasingly used in adult patients during noninvasive mechanical ventilation [5], transportation of critically ill adults [6], bronchoscopy [7], sleep studies [8,9] and pulmonary stress testing [10].…”

“…Currently, combined assessment of PtcCO 2 and partial oxygen tension using a single earlobe clip sensor is increasingly used in adult patients during noninvasive mechanical ventilation [5], transportation of critically ill adults [6], bronchoscopy [7], sleep studies [8,9] and pulmonary stress testing [10]. However, sensor preparation, positioning, taping, and the necessity for repeated calibration and repeated changes of the sensor's location because of drifting of the PtcCO 2 signal made handling cumbersome [4]. Additionally, the results of recently performed studies in neonates, infants and adults are controversial in terms of the reliability of these devices [6,[11][12][13].…”