Service de Médecine néonatale, Groupe Hospitalier Cochin-Saint Vincent de Paul, AP-HP, 123 Bd du Port-Royal, 75014 Paris, France.
Intensive Care Med. 2009 Nov;35(11):1942-9. doi: 10.1007/s00134-009-1647-5.
Monitoring CO2 levels in preterm infants receiving mechanical ventilation is designed to avoid the harmful consequences of hypocapnia or hypercapnia. Capnography is of questionable accuracy for monitoring PCO2 in preterm infants.
To determine the accuracy of sidestream capnography in ventilated preterm infants by comparing end-tidal carbon dioxide (EtCO2) values to mixed venous carbon dioxide pressure (PvCO2) and to transcutaneous carbon dioxide pressure (TcPCO2).
Simultaneous recordings of EtCO2, TcPCO2 and PvCO2 in 37 ventilated preterm infants. The PvCO2-EtCO2 gradient was calculated. The Bland-Altman technique and the intra-class correlation coefficient (ICC) were used to assess agreement between methods. The area under the curve (AUC) was calculated.
Ninety-nine EtCO2/PvCO2 pairs were studied from 37 preterm infants with a mean gestational age of 27.7 +/- 1.9 weeks and a mean birth weight of 1,003 +/- 331 g. The mean PvCO2-EtCO2 gradient was 11.2 +/- 8.0 mmHg, and the ICC was 0.28. The mean PvCO2-TcPCO2 gradient was 0 +/- 7.8 mmHg, and the ICC was 0.78. AUCs for EtCO2 and TcPCO2 were similar in detecting high or low PvCO2.
Despite an insufficient correlation between EtCO2 and PvCO2, capnography was able to detect low and high CO2 warning levels with a similar efficacy to that of TcPCO2, and may therefore be of clinical interest.
监测接受机械通气的早产儿的 CO2 水平旨在避免低碳酸血症或高碳酸血症的有害后果。旁流二氧化碳描记术在监测早产儿的 PCO2 方面准确性存在疑问。
通过比较呼气末二氧化碳（EtCO2）值与混合静脉二氧化碳分压（PvCO2）和经皮二氧化碳分压（TcPCO2），确定通气早产儿中旁流二氧化碳描记术的准确性。
对 37 例接受通气的早产儿同时记录 EtCO2、TcPCO2 和 PvCO2。计算 PvCO2-EtCO2 梯度。使用 Bland-Altman 技术和组内相关系数（ICC）评估方法之间的一致性。计算曲线下面积（AUC）。
从 37 例胎龄为 27.7±1.9 周、出生体重为 1003±331g 的早产儿中研究了 99 对 EtCO2/PvCO2。平均 PvCO2-EtCO2 梯度为 11.2±8.0mmHg，ICC 为 0.28。平均 PvCO2-TcPCO2 梯度为 0±7.8mmHg，ICC 为 0.78。EtCO2 和 TcPCO2 检测高或低 PvCO2 的 AUC 相似。
尽管 EtCO2 与 PvCO2 之间相关性不足，但二氧化碳描记术能够以与 TcPCO2 相似的效果检测到高低 CO2 警告水平，因此可能具有临床意义。
