Mukhopadhyay Sagori, Maurer Rie, Puopolo Karen M
Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Department of Pediatric Newborn Medicine and the Center of Clinical Investigation, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Respir Care. 2016 Jan;61(1):90-7. doi: 10.4187/respcare.04212. Epub 2015 Oct 27.
This work aimed to compare frequency of blood gas measurements per day of mechanical ventilation, occurrence of extreme blood gas CO2 values, and clinical outcomes among ventilated neonates managed with and without transcutaneous carbon dioxide (PtcCO2) monitors. This work also measures agreement between simultaneous PtcCO2 and blood gas CO2 measurements and ascertains factors that affect agreement.
This is a cohort study with retrospective analysis comparing 5,726 blood gas measurements and clinical outcomes for 123 neonates intubated for >48 h before and after the introduction of transcutaneous carbon-di-oxide monitoring devices in a single tertiary care unit.
Median (interquartile range) blood gas frequency per mechanical ventilation day was 3.9 (2.6-5.3) and 2.9 (2.1-4.0) before and after PtcCO2 monitoring (P = .002) without differences in clinical outcomes at discharge. After adjusting for confounders using Poisson regression, this difference remained significant. The mean ± 2 SD blood gas-PtcCO2 difference was -5.2 ± 17.3 mm Hg. 64% of simultaneous blood gas-PtcCO2 measurements per subject were within ± 7 mm Hg. Greater bias was noted with arterial sample and during the use of high-frequency ventilation.
Despite only moderate agreement between simultaneous PtcCO2 and blood gas measurements, PtcCO2 monitoring statistically decreased blood gas frequency among ventilated neonates without affecting the duration of mechanical ventilation or clinical outcomes at discharge. The clinical impact of this technology appears to be minimal.
本研究旨在比较使用和不使用经皮二氧化碳（PtcCO2）监测仪管理的机械通气新生儿每天进行血气测量的频率、极端血气二氧化碳值的发生率以及临床结局。本研究还测量了同时进行的PtcCO2和血气二氧化碳测量之间的一致性，并确定影响一致性的因素。
这是一项队列研究，采用回顾性分析，比较了在单一三级医疗单位引入经皮二氧化碳监测设备前后，123例插管超过48小时的新生儿的5726次血气测量结果和临床结局。
在PtcCO2监测之前和之后，每次机械通气日的血气测量频率中位数（四分位间距）分别为3.9（2.6 - 5.3）和2.9（2.1 - 4.0）（P = 0.002），出院时临床结局无差异。使用泊松回归调整混杂因素后，这种差异仍然显著。血气 - PtcCO2的平均±2标准差差异为 -5.2±17.3 mmHg。每位受试者同时进行的血气 - PtcCO2测量中，64%在±7 mmHg范围内。动脉样本和使用高频通气时偏差更大。
尽管同时进行的PtcCO2和血气测量之间的一致性仅为中等，但PtcCO2监测在统计学上降低了机械通气新生儿的血气测量频率，而不影响机械通气时间或出院时的临床结局。这项技术的临床影响似乎很小。
