Detar Mate, Szasz Barbara, Barta Hajnalka, Szabo Miklos, Jermendy Agnes, Szakmar Eniko
Division of Neonatology, Pediatric Center, Semmelweis University, Budapest, Hungary.
Division of Neonatology, Department of Pediatrics, BC Women's Hospital and University of British Columbia, Vancouver, BC, Canada.
Pediatr Pulmonol. 2025 May;60(5):e71144. doi: 10.1002/ppul.71144.
Primary aim was to assess the agreement between end-tidal carbon dioxide (etCO) monitoring and arterial, capillary and venous PCO values in mechanically ventilated patients receiving therapeutic hypothermia (TH) for hypoxic-ischemic encephalopathy (HIE). Secondary, to assess the percentage of time spent in predefined PCO ranges based on continuous etCO monitoring.
In this prospective observational single center trial, infants with moderate-to-severe HIE receiving conventional ventilation with sidestream capnography were enrolled. Blood gas measurements were performed based on clinical indication. The mean of 12,000 etCO values obtained over 10 min before each corresponding blood gas was used for analysis. The agreement between mean etCO and temperature corrected and uncorrected PCO at 37C were analyzed using Bland-Altman (BA) plots.
A total of 262 paired PCO and etCO values were analyzed from 35 patients. The bias between temperature corrected arterial PCO and etCO (n = 116) was 1.87 mmHg (SD 5.54) with -8.99 and 12.73 limits of agreement; whereas the bias between capillary PCO and etCO (n = 132) was 7.22 mmHg (SD 6.08). EtCO underestimated PCO of any source at 37°C. Excluding patients with lung diseases from BA analysis did not show improvement in the agreement. Infants spent median 23.9% [IQR 8.5; 36.7] of monitoring time in etCO range < 35 mmHg and median 75.0% [IQR 61.1; 87.7] in etCO range of 35-55 mmHg.
EtCO monitoring may be a valuable addition to neurocritical care of infants with HIE as it showed a strong level of agreement with temperature corrected arterial PCO.
主要目的是评估接受治疗性低温（TH）治疗缺氧缺血性脑病（HIE）的机械通气患者的呼气末二氧化碳（etCO）监测值与动脉、毛细血管和静脉血二氧化碳分压（PCO）值之间的一致性。次要目的是基于连续的etCO监测评估在预定义的PCO范围内所花费的时间百分比。
在这项前瞻性观察性单中心试验中，纳入了接受常规通气并采用旁流二氧化碳监测的中重度HIE婴儿。根据临床指征进行血气测量。在每次相应的血气分析前10分钟内获得的12000个etCO值的平均值用于分析。使用Bland-Altman（BA）图分析平均etCO与37℃时温度校正和未校正的PCO之间的一致性。
共分析了35例患者的262对PCO和etCO值。温度校正后的动脉PCO与etCO（n = 116）之间的偏差为1.87 mmHg（标准差5.54），一致性界限为-8.99和12.73；而毛细血管PCO与etCO（n = 132）之间的偏差为7.22 mmHg（标准差6.08）。在37℃时，etCO低估了任何来源的PCO。将肺部疾病患者排除在BA分析之外并未显示一致性有所改善。婴儿在etCO范围<35 mmHg内的监测时间中位数为23.9%[四分位间距8.5；36.7]，在etCO范围35 - 55 mmHg内的监测时间中位数为75.0%[四分位间距61.1；87.7]。
EtCO监测可能是HIE婴儿神经重症监护中的一项有价值的补充，因为它与温度校正后的动脉PCO显示出高度一致性。
