Transcutaneous Oxygen and Carbon Dioxide Levels and a Clinical Symptom Scale for Monitoring the Acute Asthmatic State in Infants and Young Children

Abstract

Measurement of transcutaneous PO2 and PCO2 in addition to a clinical symptom grading system was used to monitor the acute asthmatic attack in children under two years of age. tcPO2 was lowered already at signs of mild obstruction and decreased in parallel with clinical deterioration. tcPCO2 was almost unchanged at mild to moderate obstructive symptoms. With clinical deterioration tcPCO2 rose steadily. An increase of the oxygen concentration to 30-40% in the inspired air increased tcPO2, on the average by 70%, but did not change the tcPCO2, level. Continuous recording of tcPO2 and tcPCO2 as well as the clinical grading system are valuable tools when monitoring severely obstructive infants and young children.

Asthma severity scores for preschoolers displayed weaknesses in reliability, validity, and responsiveness

“…These are, in alphabetic order: Bronchiolitis Score (BS) [13], Clinical Asthma Score (CAS) [14], Clinical Asthma Evaluation Score (CAES) [15], Clinical Score (CS) [16], Clinical Symptom Grading System (CSGS) [17], Clinical Scoring System-1 (CSS 1 ) [18], Clinical Scoring System-2 (CSS 2 ) [19], Pulmonary Index (PI) [20], Preschool Respiratory Assessment Measure (PRAM) [21], and the Respiratory Distress Assessment Index (RDAI) [22]. Table 1 lists the items used in the individual asthma severity scores.…”

Lung function measurement in awake young children

“…The accuracy of ZIOS and Rint is, however, less clear. The accuracy of Ptc,O 2 is well-known with respect to arterial oxygen tension (Ptc,O 2 ), and they seem to correlate well in infants and young children [20] and even in adults [21]. However, the accuracy of Ptc,O 2 as a reflection of lung function is obscure and may be confounded by vascular flow changes.…”

“…Although Ptc,O 2 may not be an accurate measure of arterial oxygen tension (Pa,O 2 ), Ptc,O 2 and Pa,O 2 covariate during acute asthma in young and in older children and even after inhalation of the potent vasodilator, the b 2 -agonist [20,21,43]. Ptc,O 2 has previously been found to correlate to the clinical state [44], to respiratory impedance measurements [41,45], and to spirometry [46], with a precision that compared favourably with the latter [47]. In this study, Ptc,O 2 exhibited a covariation with the "gold standard" measurements of sRaw and FEV1.…”

Transcutaneous carbon dioxide monitoring in infants and children

“…There are additional reports regarding the potential utility of TC‐CO 2 monitoring during acute airway and respiratory events such as croup and status asthmaticus in spontaneously breathing infants and children (30–32). Holmgren and Sixt (30) evaluated the relationship between TC and arterial CO 2 in 14 children, ranging in age from 7 to 15 years, with status asthmaticus.…”