Agus Michael S D, Alexander Jamin L, Mantell Patricia A
Division of Endocrinology, Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
Pediatr Diabetes. 2006 Aug;7(4):196-200. doi: 10.1111/j.1399-5448.2006.00186.x.
Pediatric inpatients with diabetic ketoacidosis (DKA) are routinely subjected to frequent blood draws in order to closely monitor degree of acidosis and response to therapy. The typical level of acidosis monitoring is less than ideal, however, because of the high cost and invasiveness of frequent blood labs. Previous studies have validated end-tidal carbon dioxide (EtCO2) monitoring in the emergency department (ED) for varying periods of time. We extend these findings to the inpatient portion of the hospitalization during which the majority of blood tests are sent.
All patients admitted to an intermediate care unit in (InCU) a large children's hospital were fitted with an appropriately sized oral/nasal cannula capable of sensing EtCO2. Laboratory studies were obtained according to hospital clinical practice guidelines. In a retrospective analysis, EtCO2 values were correlated with serum total CO2 (stCO2), venous pH (vpH), venous pCO2 (vpCO2), and calculated bicarbonate from venous blood gas (vHCO3-).
A total of 78 consecutive episodes of DKA in 72 patients aged 1-21 yr were monitored for 3-38 h with both capnography and laboratory testing, producing 334 comparisons. Initial values were as follows, reported as median (range): stCO2, 11 (4-22) mmol/L; vpH, 7.281 (6.998-7.441); vpCO2, 28.85 (9.3-43.3) mmHg; and vHCO3-, 14 (3-25) mmol/L. EtCO2 was correlated well with stCO2 (r = 0.84, p < 0.001), vHCO3- (r = 0.84, p < 0.001), and vpCO2 (r = 0.79, p < 0.001).
These data support the findings of previous studies limited to ED populations and suggest that non-invasive EtCO2 monitoring is a valuable and reliable tool to continuously follow acidosis in the setting of the acutely ill pediatric patient with DKA. Continuous EtCO2 monitoring offers the practitioner an early warning system for unexpected changes in acidosis that augments the utility of intermittent blood gas determinations.
糖尿病酮症酸中毒（DKA）的儿科住院患者通常需要频繁采血，以便密切监测酸中毒程度和治疗反应。然而，由于频繁进行血液检查成本高且具有侵入性，典型的酸中毒监测水平并不理想。先前的研究已经验证了急诊科（ED）在不同时间段内进行呼气末二氧化碳（EtCO2）监测的有效性。我们将这些发现扩展到住院期间大部分血液检查送检的住院部。
一家大型儿童医院中级护理病房（InCU）收治的所有患者均佩戴了尺寸合适、能够检测EtCO2的口鼻插管。根据医院临床实践指南进行实验室检查。在一项回顾性分析中，将EtCO2值与血清总二氧化碳（stCO2）、静脉血pH值（vpH）、静脉血二氧化碳分压（vpCO2）以及根据静脉血气计算的碳酸氢盐（vHCO3-）进行相关性分析。
对72例年龄在1至21岁的患者连续发生的78次DKA发作进行了3至38小时的二氧化碳描记法和实验室检测监测，共进行了334次比较。初始值如下，以中位数（范围）报告：stCO2，11（4 - 22）mmol/L；vpH，7.281（6.998 - 7.441）；vpCO2，28.85（9.3 - 43.3）mmHg；vHCO3-，14（3 - 25）mmol/L。EtCO2与stCO2（r = 0.84，p < 0.001）、vHCO3-（r = 0.84，p < 0.001）和vpCO2（r = 0.79，p < 0.001）相关性良好。
这些数据支持了先前仅限于急诊科人群的研究结果，并表明无创EtCO2监测是在患有DKA的急性病儿科患者中持续跟踪酸中毒情况的一种有价值且可靠的工具。持续EtCO2监测为从业者提供了一个针对酸中毒意外变化的早期预警系统，增强了间歇性血气测定的效用。
