Poor performance of main‐stream capnography in newborn infants during general anesthesia

Karlsson, Victoria; Sporre, Bengt; Hellström‐Westas, Lena; Ågren, Johan

doi:10.1111/pan.13266

Cited by 12 publications

(9 citation statements)

References 18 publications

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“…Long-term ventilator management in a larger study suggested moderate correlation of tcP CO2 with arterial CO 2 levels, although bias was greater when transcutaneous monitoring was employed in HFOV 11. In addition, a recent study demonstrated poor correlation between Et CO2 and Pv CO2 in anesthetized neonates for general surgery 12. Similar effects have been noted for Pa CO2 as well 13.…”

Section: Discussionmentioning

confidence: 79%

Transcutaneous CO2 versus end-tidal CO2 in neonates and infants undergoing surgery: a prospective study

Chandrakantan¹,

Jasiewicz²,

Reinsel³

et al. 2019

MDER

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Aim: End-tidal CO 2 (Et CO2 ) is the standard in operative care along with pulse oximetry for ventilation assessment. It is known to be less accurate in the infant population than in adults. Many neonatal intensive care units (NICU) have converted to utilizing transcutaneous CO 2 (tcP CO2 ) monitoring. 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. 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. P CO2 was monitored with Et CO2 and with tcP CO2 . Venous blood gas (Pv CO2 ) samples were drawn at the end of the anesthetic. 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. The mean differences in the NICU and non-NICU patients were compared by t-tests and Bland–Altman analysis. Results: Median age was 10.9 weeks, and median weight was 4.4 kg. NICU (n=6) and non-NICU (n=14) patients did not differ in Pv CO2 . 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). Delta tcP CO2 was close to zero in both groups. 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). Conclusions: Et CO2 underestimates Pv CO2 values in neonates and infants under general anesthesia. TcP CO2 closely approximates venous blood gas values, in both the NICU and non-NICU samples. We, therefore, conclude that tcP CO2 is a more accurate measure of operative Pv CO2 in infants, especially in NICU patients.

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Section: Discussionmentioning

confidence: 79%

Transcutaneous CO2 versus end-tidal CO2 in neonates and infants undergoing surgery: a prospective study

Chandrakantan¹,

Jasiewicz²,

Reinsel³

et al. 2019

MDER

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“…Prompt recognition by trending EtCO 2 or TcPCO 2 may allow for expedient ventilatory management. However, on comparing EtCO 2 and PaCO 2 from 23 prospectively enrolled infants (59 sample sets) during general anesthesia and surgery, mainstream capnography correlated poorly with PaCO 2 [ 97 ]. Thus, EtCO 2 should not be solely relied upon while making ventilatory changes during surgery.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive carbon dioxide monitoring in neonates: methods, benefits, and pitfalls

et al. 2021

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Wide fluctuations in partial pressure of carbon dioxide (PaCO 2 ) can potentially be associated with neurological and lung injury in neonates. Blood gas measurement is the gold standard for assessing gas exchange but is intermittent, invasive, and contributes to iatrogenic blood loss. Non-invasive carbon dioxide (CO 2 ) monitoring has become ubiquitous in anesthesia and critical care and is being increasingly used in neonates. Two common methods of non-invasive CO 2 monitoring are end-tidal and transcutaneous. A colorimetric CO 2 detector (a modified end-tidal CO 2 detector) is recommended by the International Liaison Committee on Resuscitation (ILCOR) and the American Academy of Pediatrics to confirm endotracheal tube placement. Continuous CO 2 monitoring is helpful in trending PaCO 2 in critically ill neonates on respiratory support and can potentially lead to early detection and minimization of fluctuations in PaCO 2 . This review includes a description of the various types of CO 2 monitoring and their applications, benefits, and limitations in neonates.

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“…Authors of another study stated that the correlation between PcCO 2 and mainstream ETCO 2 during anesthesia and surgical intervention in newborns was poor. 9 In the present study, the lack of newborns and the small sample size did not allow a comparison with that study. In a recent study, a sufficient number of ABG, CBG, and PtcCO 2 measurements were compared, and the authors reported that CBG comparisons showed less variation and a slightly lower correlation with PtcCO 2 than did ABG comparisons.…”

Section: Discussionmentioning

confidence: 65%

“…7 Although many studies have investigated the correlation between PaCO 2 levels and ETCO 2 levels, there are a limited number of pediatric studies in the literature that have investigated the relationship between ETCO 2 and capillary PCO 2 (PcCO 2 ). [8][9][10] Also, almost none of these studies have examined the variable conditions such as acute respiratory failure (RF).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Simultaneous Capillary Blood Gases and End-Tidal Carbon Dioxide in Mechanically Ventilated Pediatric Patients with Acute Respiratory Failure

Konca

Tekin

Üçkardeş

et al. 2020

J Pediatr Intensive Care

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In the follow-up of ventilation, invasive blood gas analysis and noninvasive monitoring of end-tidal carbon dioxide (ETCO2) are used. We aimed to investigate the relationship between capillary partial pressure of carbon dioxide (PcCO2) levels and ETCO2 and also to investigate ETCO2's predictive feature of PcCO2 levels. This study included 28 female and 30 male pediatric patients; 28 patients were type-1 respiratory failure (RF), 16 patients were acute respiratory distress syndrome, and 14 patients were type-2 RF. Our results showed a significant correlation between ETCO2 and PcCO2. Although the strength of the correlation was weak throughout the measurements, the strength of this correlation increased significantly in type-2 RF.

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Poor performance of main‐stream capnography in newborn infants during general anesthesia

Abstract: Main-stream capnography during anesthesia and surgery correlated poorly to blood gas values in small and/or respiratory compromised infants. We conclude that caution should be exercised when relying solely on ET measurements to guide mechanical ventilation in the OR.

Cited by 12 publications

References 18 publications

<p>Transcutaneous CO<sub>2</sub> versus end-tidal CO<sub>2</sub> in neonates and infants undergoing surgery: a prospective study</p>

<p>Transcutaneous CO<sub>2</sub> versus end-tidal CO<sub>2</sub> in neonates and infants undergoing surgery: a prospective study</p>

Non-invasive carbon dioxide monitoring in neonates: methods, benefits, and pitfalls

Comparison of Simultaneous Capillary Blood Gases and End-Tidal Carbon Dioxide in Mechanically Ventilated Pediatric Patients with Acute Respiratory Failure

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