验证一种新的经皮 tcPCO 和 tcPO 联合传感器在手术室中儿童的应用。
Validation of a new combined transcutaneous tcPCO and tcPO sensor in children in the operating theater.
机构信息
Department of Anesthesiology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.
出版信息
Paediatr Anaesth. 2022 Mar;32(3):429-435. doi: 10.1111/pan.14375. Epub 2021 Dec 15.
BACKGROUND
Arterial blood gas analysis is the gold standard for monitoring of P CO and PaO during mechanical ventilation. However, continuous measurements would be preferred. Transcutaneous sensors continuously measure blood gases diffusing from the locally heated skin. These sensors have been validated in children mostly in intensive care settings. Accuracy in children during general anesthesia is largely unknown.
AIMS
We conducted a study in children undergoing general anesthesia to validate the use and to determine the accuracy of continuous transcutaneous measurements of the partial pressures of PCO (tcPCO ) and PO (tcPO ).
METHODS
A prospective observational study in a tertiary care pediatric hospital in The Netherlands, from April to October 2018, in children aged 0-18 years undergoing general anesthesia. Patients were included when endotracheally intubated and provided with an arterial catheter for regular blood sampling. Patients with a gestational age <31 weeks, burn victims, and patients with skin disease were excluded. TcPCO and tcPO measurements were performed with a SenTec OxiVenT sensor (SenTec AG). Accuracy was determined with an agreement analysis between arterial and transcutaneous PCO and PO values, and between arterial and endtidal PCO (etCO ) values, according to Bland and Altman, accounting for multiple measurements per subject.
RESULTS
We included 53 patients (median age 4.1 years, IQR 0.7-14.4 years) and retrieved 175 samples. TcPCO -P CO agreement analysis provided a bias of 0.06 kPa (limits of agreement (LOA) -1.18 to 1.31), the etCO -P CO agreement showed a bias of -0.31 kPa (LOA -1.38 to 0.76). Results of the tcPO -PaO agreement showed a bias of 3.40 to 0.86* (mean tension) kPa.
CONCLUSIONS
This study showed good agreement between P CO and tcPCO in children of all ages during general anesthesia. Both transcutaneous and endtidal CO measurements showed good accuracy. TcPO is only accurate under 6 months of age.
背景
动脉血气分析是监测机械通气期间 P CO 和 PaO 的金标准。然而，连续测量则更受欢迎。经皮传感器连续测量从局部加热的皮肤扩散的血气。这些传感器已在儿童重症监护环境中得到验证。在全身麻醉期间，儿童的准确性在很大程度上尚不清楚。
目的
我们在接受全身麻醉的儿童中进行了一项研究，以验证连续经皮测量 P CO （tcPCO ）和 PO （tcPO ）分压的使用并确定其准确性。
方法
这是 2018 年 4 月至 10 月在荷兰一家三级儿童医院进行的前瞻性观察研究，纳入年龄在 0-18 岁、接受全身麻醉并经气管内插管和动脉导管常规采血的儿童。排除胎龄<31 周的烧伤患者和患有皮肤病的患者。tcPCO 和 tcPO 测量使用 SenTec OxiVenT 传感器（SenTec AG）进行。准确性通过动脉血气与经皮血气 PCO 和 PO 值之间的一致性分析以及动脉血气与潮气末 PCO （etCO ）值之间的一致性分析来确定，根据 Bland 和 Altman 分析，每个受试者有多个测量值。
结果
我们纳入了 53 名患者（中位年龄 4.1 岁，IQR 0.7-14.4 岁），并获得了 175 个样本。tcPCO -P CO 一致性分析显示偏差为 0.06kPa（界限为-1.18 至 1.31），etCO -P CO 一致性分析显示偏差为-0.31kPa（界限为-1.38 至 0.76）。tcPO -PaO 一致性分析结果显示，差值为 3.40 至 0.86*（平均张力）kPa。
结论
本研究表明，全身麻醉期间所有年龄段儿童的 P CO 与 tcPCO 之间具有良好的一致性。经皮和潮气末 CO 测量均具有良好的准确性。tcPO 仅在 6 个月以下时准确。
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