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PEDIATRIC ANESTHESIA

Transcutaneous Monitoring of Carbon Dioxide Tension After Cardiothoracic Surgery in Infants and Children

Joseph D. Tobias, MD^*,,§, William R. Wilson, Jr., MD^*,,||, and D. Joseph Meyer, MD, PhD^*,

Departments of *Child Health, Anesthesiology, Surgery, and the Divisions of §Pediatric Critical Care/Pediatric Anesthesiology and ||Pediatric Cardiothoracic Surgery, The University of Missouri, Columbia, Missouri

Address correspondence and reprint requests to Joseph D. Tobias, MD, Department of Child Health, The University of Missouri, M658 Health Sciences Center, One Hospital Dr., Columbia, MO 65212. Address e-mail to Joseph_Tobias{at}muccmail.missouri.edu

In this prospective investigation, we evaluated the efficacy and accuracy of transcutaneous monitoring of CO₂ (TC-CO₂) in infants and children after cardiothoracic surgery. Cardiothoracic surgery patients whose ETCO₂ and arterial CO₂ values did not correlate (gradient 5 mm Hg) during the first postoperative hour underwent placement of the TC electrode (30 of 33 patients). If the TC-CO₂ to arterial difference was 5 mm Hg, the TC-CO₂ electrode was recalibrated and reapplied on another site. If the discrepancy was still 5 mm Hg, the case was considered a clinical failure and no further data were collected (3 of 30 patients). If the arterial to TC gradient was <5 mm Hg, the patient was included in the data collection (27 of 30 patients). One to five sample sets (TC and arterial CO₂) were collected from these patients. Statistical analysis included linear regression analysis and Bland-Altman analysis. The cohort for the study included 27 patients ranging in age from 2 days to 9 yr and in weight from 3.2 to 25 kg. A total of 101 sample sets were analyzed. The mean ± SD absolute difference between the TC-CO₂ and arterial CO₂ was 1.7 ± 1.4 mm Hg (range 0–9 mm Hg). The TC-CO₂ to arterial CO₂ difference was 0–2 mm Hg in 82 of 101 values (81%), 3–5 mm Hg in 18 of 101 values (18%), and >6 mm Hg in 1 of 101 values (1%). Linear regression analysis revealed a slope of 0.90, an r value of 0.9410, and an r² value of 0.8854 (P < 0.0001). Bland-Altman analysis revealed a bias of 0.58 mm Hg with a precision of ±2.1 mm Hg when comparing the TC-CO₂ with the arterial CO₂.

Implications: We conclude that, with certain caveats in mind, including the need to correlate the transcutaneous CO₂ with an initial arterial CO₂ value, transcutaneous CO₂ monitoring can be used to estimate arterial CO₂ in most neonates and children after cardiothoracic surgery.

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				J. Wilson, P. Russo, J. Russo, and J. D. Tobias Noninvasive Monitoring of Carbon Dioxide in Infants and Children With Congenital Heart Disease: End-Tidal Versus Transcutaneous Techniques J Intensive Care Med, September 1, 2005; 20(5): 291 - 295. [Abstract] [PDF]

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999