Division of Neonatology, Department of Pediatrics, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands,
Division of Neonatology, Department of Pediatrics, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Neonatology. 2023;120(3):308-316. doi: 10.1159/000529187. Epub 2023 Mar 30.
Transcutaneous blood gas monitoring allows for continuous non-invasive evaluation of carbon dioxide and oxygen levels. Its use is limited as its accuracy is dependent on several factors. We aimed to identify the most influential factors to increase usability and aid in the interpretation of transcutaneous blood gas monitoring.
In this retrospective cohort study, transcutaneous blood gas measurements were paired to arterial blood gas withdrawals in neonates admitted to the neonatal intensive care unit. The effects of patient-related, microcirculatory, macrocirculatory, respiratory, and sensor-related factors on the difference between transcutaneously and arterially measured carbon dioxide and oxygen values (ΔPCO2 and ΔPO2) were evaluated using marginal models.
A total of 1,578 measurement pairs from 204 infants with a median [interquartile range] gestational age of 273/7 [261/7-313/7] weeks were included. ΔPCO2 was significantly associated with the postnatal age, arterial systolic blood pressure, body temperature, arterial partial pressure of oxygen (PaO2), and sensor temperature. ΔPO2 was, with the exception of PaO2, additionally associated with gestational age, birth weight Z-score, heating power, arterial partial pressure of carbon dioxide, and interactions between sepsis and body temperature and sepsis and the fraction of inspired oxygen.
The reliability of transcutaneous blood gas measurements is affected by several clinical factors. Caution is recommended when interpreting transcutaneous blood gas values with an increasing postnatal age due to skin maturation, lower arterial systolic blood pressures, and for transcutaneously measured oxygen values in the case of critical illness.
经皮血气监测可连续无创评估二氧化碳和氧水平。其准确性取决于多个因素，因此其应用受到限制。我们旨在确定最具影响力的因素，以提高可用性并有助于解释经皮血气监测。
在这项回顾性队列研究中，将经皮血气测量值与新生儿重症监护病房收治的新生儿的动脉血气抽取进行配对。使用边缘模型评估患者相关、微循环、大循环、呼吸和传感器相关因素对经皮和动脉测量的二氧化碳和氧值（ΔPCO2 和 ΔPO2）之间差异的影响。
共纳入 204 例婴儿的 1578 对测量值，中位（四分位距）胎龄为 273/7 [261/7-313/7] 周。ΔPCO2 与出生后年龄、动脉收缩压、体温、动脉氧分压（PaO2）和传感器温度显著相关。ΔPO2 除了 PaO2 外，还与胎龄、出生体重 Z 评分、加热功率、动脉二氧化碳分压以及败血症与体温和败血症与吸入氧分数之间的相互作用有关。
经皮血气测量的可靠性受多种临床因素影响。由于皮肤成熟、动脉收缩压降低以及危重病患者经皮测量的氧值，建议在解释经皮血气值时要谨慎，尤其是在出生后年龄增加的情况下。
