儿童机械通气撤机过程中的经皮二氧化碳监测：WeanCO研究
Transcutaneous Carbon Dioxide Monitoring During Weaning From Mechanical Ventilation in Children: The WeanCO Study.
作者信息
Vedrenne-Cloquet Meryl, Collignon Charlotte, De Cacqueray Noémie, Grapin Mathilde, Oualha Mehdi, Renolleau Sylvain, Griffon Lucie, Khirani Sonia, Fauroux Brigitte
机构信息
Pediatric Intensive Care Unit, AP-HP University Hospital Necker-Enfants malades, Paris, France.
Pediatric Noninvasive Ventilation and Sleep Unit, EA 7330 VIFASOM, AP-HP University Hospital Necker-Enfants malades, Paris, France.
出版信息
Pediatr Pulmonol. 2025 May;60(5):e71115. doi: 10.1002/ppul.71115.
INTRODUCTION
Spontaneous breathing trial (SBT) is recommended during weaning from mechanical ventilation (MV), but objective and easy tools lack to identify pediatric weaning failure. We aimed to assess whether changes in estimated arterial CO₂ (PaCO₂) derived from transcutaneous measurements (PCO₂) were associated with pediatric weaning failure.
METHODS
Children (age 72 h -18 years) with MV > 12 h were continuously monitored using a transcutaneous sensor to estimate PaCO₂ from skin CO₂ tension (PCO₂). Values were recorded during SBT (30 min on positive end-expiratory pressure (PEEP) +5 cmHO, with pressure support of +5 cmHO for endotracheal tubes with internal diameter ≤ 3.5 mm), then up to 6 h after extubation. Mean PCO and PCO changes during SBT, and after extubation, were retrospectively collected to evaluate their association with SBT failure and extubation failure (reintubation within 48 h).
RESULTS
Eighty children (median [IQR] age 1.1 [0.3; 8.7] years) were included, with 89 SBT (14 failures, 75 successes). Sixty-four patients were extubated following their first SBT, with 10 (16%) extubation failures. PCO changes were not associated with SBT and extubation failures. Patients who failed extubation had a higher mean PCO value after extubation as compared to those who were successfully extubated (mean PCO of 51.8 [46.2; 55.4] vs. 42.3 [37.5; 47.2] mmHg, p = 0.02). The difference between the maximal PCO value within the 2 h following extubation and the value at extubation were higher in patients who failed extubation (ΔPCO of 20 [9.1; 26] vs. 6.8 [2.9; 9.7] mmHg, p < 10).
CONCLUSION
Early post-extubation increase in estimated PaCO₂ was associated with extubation failure, whereas PCO₂ changes during SBT were not.
引言
在机械通气（MV）撤机过程中推荐进行自主呼吸试验（SBT），但缺乏客观且简便的工具来识别小儿撤机失败。我们旨在评估经皮测量得出的估计动脉血二氧化碳分压（PaCO₂）（PCO₂）变化是否与小儿撤机失败相关。
方法
对机械通气时间超过12小时的72小时至18岁儿童使用经皮传感器持续监测，以根据皮肤二氧化碳张力（PCO₂）估计PaCO₂。在自主呼吸试验期间（呼气末正压（PEEP）为+5 cmH₂O，内径≤3.5 mm的气管插管压力支持为+5 cmH₂O，持续30分钟）记录数值，然后在拔管后长达6小时内记录。回顾性收集自主呼吸试验期间及拔管后平均PCO₂和PCO₂变化，以评估它们与自主呼吸试验失败和拔管失败（48小时内再次插管）之间的关联。
结果
纳入80名儿童（年龄中位数[四分位间距]为1.1[0.3；8.7]岁），进行了89次自主呼吸试验（14次失败，75次成功）。64名患者在首次自主呼吸试验后拔管，其中10名（16%）拔管失败。PCO₂变化与自主呼吸试验和拔管失败无关。与成功拔管的患者相比，拔管失败的患者拔管后平均PCO₂值更高（平均PCO₂分别为51.8[46.2；55.4] mmHg和42.3[37.5；47.2] mmHg，p = 0.02）。拔管失败的患者拔管后2小时内的最大PCO₂值与拔管时的值之间的差值更高（ΔPCO₂分别为20[9.1；26] mmHg和6.8[2.9；9.7] mmHg，p < 0.01）。
结论
拔管后早期估计的PaCO₂升高与拔管失败相关，而自主呼吸试验期间的PCO₂变化则无关。
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