Neonatal Transcutaneous Carbon Dioxide Monitoring--Effect on Clinical Management and Outcomes

• Published in: Respiratory care 2016-01, Vol.61 (1), p.90-97
• Main Authors: Mukhopadhyay, Sagori, Maurer, Rie, Puopolo, Karen M
• Format: Article
• Language: English
• Subjects: Blood Gas Analysis - statistics & numerical data; Blood Gas Monitoring, Transcutaneous; Carbon dioxide; Carbon Dioxide - blood; Female; Health aspects; Humans; Infant, Newborn; Infants (Newborn); Intensive Care, Neonatal - methods; Male; Monitoring, Physiologic - methods; Patient outcomes; Respiration, Artificial; Respiratory Insufficiency - blood; Respiratory Insufficiency - therapy; Retrospective Studies; Time Factors; Treatment Outcome
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.04212

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.