Open AccessNoninvasive Monitoring of Carbon Dioxide During Mechanical Ventilation in Older Children: End-Tidal Versus Transcutaneous Techniques
Author(s) -
John W. Berkenbosch,
Janet Lam,
Randall S. Burd,
Joseph D. Tobias
Publication year - 2001
Publication title -
anesthesia and analgesia/anesthesia and analgesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.404
H-Index - 201
eISSN - 1526-7598
pISSN - 0003-2999
DOI - 10.1097/00000539-200106000-00015
Subject(s) - medicine , anesthesia , capnography , mechanical ventilation , correlation coefficient , ventilation (architecture) , arterial blood , tidal volume , respiratory system , mechanical engineering , statistics , mathematics , engineering
We prospectively compared the accuracy of end-tidal CO(2) (ETCO(2)) and transcutaneous CO(2) (TCCO(2)) monitoring in older pediatric patients (4 yr or older) receiving mechanical ventilation for respiratory failure. ETCO(2) and TCCO(2) were simultaneously monitored and compared with arterial CO(2) (PaCO(2)) values when arterial blood gas analysis was performed. Eighty-two sample sets were compared. The ETCO(2) to PaCO(2) difference was 6.4 +/- 6.3 mm Hg, whereas the TCCO(2) to PaCO(2) difference was 2.6 +/- 2.0 mm Hg (P < 0.0001). The absolute difference of ETCO(2) and PaCO(2) was 5 or less in 47 of 82 measurements, whereas the absolute TCCO(2) to PaCO(2) difference was 5 or less in 76 of 82 measurements (P < 0.00001). Regression analysis of ETCO(2) and PaCO(2) values revealed a correlation coefficient of 0.5418 and an r value of 0.8745. Regression analysis of TCCO(2) and PaCO(2) values revealed a correlation coefficient of 1.0160 and an r value of 0.9693. Bland-Altman analysis revealed a bias of -5.68 with a precision of +/-6.93 when comparing ETCO(2) with PaCO(2) and a bias of 0.02 with a precision of +/-3.27 when comparing TCCO(2) and PaCO(2) (P < 0.00001). TCCO(2) monitoring provided an accurate estimation of PaCO(2) over a wide range of CO(2) values and was superior to ETCO(2) monitoring in older pediatric patients with respiratory failure. TCCO(2) monitoring may be considered as a useful adjunct to monitoring of ventilation in this patient population.