Lacerenza Serafina, De Carolis Maria Pia, Fusco Francesca Paola, La Torre Giuseppe, Chiaradia Giacomina, Romagnoli Costantino
Division of Neonatology, Department of Pediatrics, Institute of Hygiene, Catholic University of Sacred Heart, Rome, Italy.
Anesth Analg. 2008 Jul;107(1):125-9. doi: 10.1213/ane.0b013e3181733e47.
Recently, a new sensor for combined assessment of pulse oximetry oxygen saturation (Spo(2)) and transcutaneous monitoring of carbon dioxide partial pressure (PtcCO(2)) has been introduced (TOSCA 500, Radiometer basel AG, Switzerland) [corrected] We designed this study to evaluate the usability and reliability of TOSCA in neonates with birth weight <or=1500 g (very low birth weight).
In a prospective study of 22 newborns, TOSCA was tested, positioning the sensor on the ear pinna with an adhesive attachment clip. Simultaneous monitoring with TOSCA, conventional pulse oximeter (HP; Datex Ohmeda 3740), and a transcutaneous device (TINA TCM3, Radiometer, Copenhagen) was performed for 60 min. PtcCO(2) measurement from TOSCA (PtcCO(2TOSCA)) and TINA (PtcCO(2)) were compared with Pco(2) from blood samples (PCO(2EAB)) at 1 and 60 min. During the monitoring period, values of PtcCO(2TOSCA) were compared with PtcCO(2), and SatO(2) values from TOSCA with those from a pulse oximeter. Corresponding data were compared using Bland-Altman analysis.
Bias (precision) at 1 min and at 60 min between PCO(2EAB) and PtcCO(2) values were 3.5 (12.4) mm Hg and 2.8 (10.2), respectively, whereas between PCO(2EAB) and PtcCO(2TOSCA) values were 18.3 (30.4) mm Hg and 1.8 (25) mm Hg. Bland-Altman analysis shows a better correspondence PtcCO(2)/PtcCO(2TOSCA) between 7 and 15 min. No significant differences were found between Spo(2) and SpO(2TOSCA).
The TOSCA monitor is safe and easy to apply in very low birth weight newborns. The pulse oximeter measurements may be useful for titrating oxygen therapy. Pco(2) measurement with TOSCA is most useful as a trend and independent confirmation of arterial Pco(2) is required if an accurate value is needed.
最近，一种用于联合评估脉搏血氧饱和度（Spo₂）和经皮监测二氧化碳分压（PtcCO₂）的新型传感器已被推出（TOSCA 500，瑞士 Radiometer basel AG公司）[已修正]。我们设计了本研究，以评估TOSCA在出生体重≤1500g（极低出生体重）新生儿中的可用性和可靠性。
在一项对22例新生儿的前瞻性研究中，对TOSCA进行测试，使用粘性固定夹将传感器置于耳廓上。同时使用TOSCA、传统脉搏血氧仪（惠普；Datex Ohmeda 3740）和经皮监测设备（TINA TCM3，丹麦Radiometer公司）进行60分钟的监测。在1分钟和60分钟时，将TOSCA测得的PtcCO₂（PtcCO₂TOSCA）和TINA测得的PtcCO₂与血样中的Pco₂（PCO₂EAB）进行比较。在监测期间，将PtcCO₂TOSCA的值与PtcCO₂进行比较，将TOSCA测得的SatO₂值与脉搏血氧仪测得的值进行比较。使用Bland-Altman分析比较相应数据。
在1分钟和60分钟时，PCO₂EAB与PtcCO₂值之间的偏差（精密度）分别为3.5（12.4）mmHg和2.8（10.2）mmHg，而PCO₂EAB与PtcCO₂TOSCA值之间的偏差分别为18.3（30.4）mmHg和1.8（25）mmHg。Bland-Altman分析显示，在7至15分钟之间，PtcCO₂/PtcCO₂TOSCA的对应性更好。Spo₂与SpO₂TOSCA之间未发现显著差异。
TOSCA监测仪在极低出生体重新生儿中使用安全且易于应用。脉搏血氧仪测量值可能有助于调整氧疗。使用TOSCA测量Pco₂最适用于监测趋势，如需准确值，则需要独立确认动脉Pco₂。
