Transcutaneous [CO.sub.2] versus end-tidal [CO.sub.2] in neonates and infants undergoing surgery: a prospective study

• Published in: Medical devices (Auckland, N.Z.) p. 165
• Main Authors: Chandrakantan, Arvind, Jasiewicz, Ronald, Reinsel, Ruth A, Khmara, Kseniya, Mintzer, Jonathan, DeCristofaro, Joseph D, Jacob, Zvi, Seidman, Peggy
• Format: Journal Article
• Language: English
• Published: Dove Medical Press Limited 01.05.2019
• Subjects: Analysis; Anesthesia; Central nervous system agents; Ethical aspects; Informed consent; Neonatal intensive care; Newborn infants; Parenting; Patient monitoring equipment; Pediatric anesthesia; Pediatrics; Surgery
• ISSN: 1179-1470; 1179-1470
• DOI: 10.2147/MDER.S198707

Aim: End-tidal [CO.sub.2] ([Et.sub.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.sub.2] ([tcP.sub.CO2]) monitoring. This study aimed to compare perioperative [Et.sub.CO2] to [tcP.sub.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.sub.CO2] was monitored with [Et.sub.CO2] and with [tcP.sub.CO2]. Venous blood gas ([Pv.sub.CO2]) samples were drawn at the end of the anesthetic. We calculated a mean difference of [Et.sub.CO2] minus [Pv.sub.CO2] (Delta [Et.sub.CO2]), and [tcP.sub.CO2] minus [Pv.sub.CO2] (Delta [tcP.sub.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.sub.CO2]. Relative to the [Pv.sub.CO2], the Delta [Et.sub.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.sub.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.sub.CO2] measurements differed significantly from zero (P<0.05). Conclusions: [Et.sub.CO2] underestimates [Pv.sub.CO2] values in neonates and infants under general anesthesia. Tc[P.sub.CO2] closely approximates venous blood gas values, in both the NICU and non-NICU samples. We, therefore, conclude that [tcP.sub.CO2] is a more accurate measure of operative [Pv.sub.CO2] in infants, especially in NICU patients. Keywords: infant, newborn, end-tidal [CO.sub.2], blood gas monitoring-transcutaneous, intensive care monitoring- neonatal, ASA monitoring standards