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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Mukhopadhs@email.chop.edu.
Sagori
S
Mukhopadhyay
Department of Pediatric Newborn Medicine and the Center of Clinical Investigation, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Rie
R
Maurer
Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Karen M
KM
Puopolo
D001784:Blood Gas Analysis / Q000706:statistics & numerical data; D001785:Blood Gas Monitoring, Transcutaneous; D002245:Carbon Dioxide / Q000097:blood; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000379:methods; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000097:blood* / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D002245:Carbon Dioxide
capnometry; neonatal; outcomes; transcutaneous monitoring