title: Measurement of gastric-to-end-tidal carbon dioxide difference in neonates requiring intensive care.
abstract: OBJECTIVE
  Gastric-arterial partial CO(2) pressure gap (P(g-)(a)CO(2) gap) measured by gastric tonometry may detect the disturbance of splanchnic perfusion. As in the neonatal age it is very difficult to follow up the circulatory condition with frequent acid-base examinations, we wanted to compare the P(g-)(a)CO(2) gap with an alternative gap of P(g)CO(2) - end-tidal carbon dioxide (P(g)(-)(ET)CO(2) gap).
  
  
  METHODS
  A prospective study was performed on ventilated neonates requiring intensive therapy (n = 44, weight: 1813 ± 977 g). P(ET)CO(2) and P(g)CO(2) were measured with a side stream capnograph. We applied a newly developed gastric tonometric probe. Patients were divided into two groups: Group 1 of patients in stable condition (n = 35) and Group 2 of patients with severe condition (i.e. Clinical Risk Index for Babies [CRIB] score higher than 10; n = 9). For main statistical analysis a mixed model repeated measurements ANOVA, Bland-Altman analysis were applied.
  
  
  RESULTS
  P(g)(-)(ET)CO(2) gap was higher than P(g-)(a)CO(2) gap (11.40 ± 7.79 versus 3.63 ± 7.98 mmHg, p < 0.01). Both gaps were higher in Group 2 (8.71 ± 10.89 and 18.27 ± 10.49 versus 2.53 ± 6.78 and 9.92 ± 6.22 mmHg, p < 0.01 and p < 0.05). Bland-Altman analysis of the two gaps showed an acceptable correspondence.
  
  
  CONCLUSIONS
  P(g)(-)(ET)CO(2) gap may be used as a method for continuous estimation of splanchnic perfusion and a prognostic index also in critically ill neonates. However, the P(g-)(a)CO(2) gap should not be abandoned.
authors.affiliation: Department of Paediatrics, University of Szeged, Szeged, Hungary. drszakalo@gmail.com
authors.forename: Orsolya
authors.initials: O
authors.lastname: Szakál
authors.forename: Agnes
authors.initials: A
authors.lastname: Király
authors.forename: Dániel
authors.initials: D
authors.lastname: Szűcs
authors.forename: Márta
authors.initials: M
authors.lastname: Katona
authors.forename: Domokos
authors.initials: D
authors.lastname: Boda
authors.forename: Gyula
authors.initials: G
authors.lastname: Tálosi
mesh_terms: D001724:Birth Weight / Q000502:physiology; D019296:Capnography / Q000295:instrumentation / Q000379:methods; D002245:Carbon Dioxide / Q000032:analysis* / Q000378:metabolism; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy; D005753:Gastric Mucosa / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000378:metabolism / Q000628:therapy*; D007363:Intensive Care Units, Neonatal; D008365:Manometry / Q000295:instrumentation / Q000379:methods; D012121:Respiration, Artificial; D013270:Stomach / Q000737:chemistry*; D013990:Tidal Volume / Q000502:physiology*
chemical_list: D002245:Carbon Dioxide