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PEDIATRIC ANESTHESIA

Noninvasive Monitoring of Carbon Dioxide During Mechanical Ventilation in Older Children: End-Tidal Versus Transcutaneous Techniques

John W. Berkenbosch, MD^*, Janet Lam, MHS^*, Randall S. Burd, MD, PhD, and Joseph D. Tobias, MD^*||

*Department of Child Health; Division of Pediatric Critical Care/Pediatric Anesthesiology; Department of Surgery; Division of Pediatric Surgery; and ||Department of Anesthesiology, University of Missouri, Columbia, Missouri

Address correspondence and reprint requests to John W. Berkenbosch, MD, Assistant Professor, Pediatric Critical Care, Department of Child Health, The University of Missouri, One Hospital Drive, Columbia, MO 65212. Address e-mail to berkenboschj{at}health.missouri.edu

We prospectively compared the accuracy of end-tidal CO₂ (ETCO₂) and transcutaneous CO₂ (TCCO₂) monitoring in older pediatric patients (4 yr or older) receiving mechanical ventilation for respiratory failure. ETCO₂ and TCCO₂ were simultaneously monitored and compared with arterial CO₂ (PaCO₂) values when arterial blood gas analysis was performed. Eighty-two sample sets were compared. The ETCO₂ to PaCO₂ difference was 6.4 ± 6.3 mm Hg, whereas the TCCO₂ to PaCO₂ difference was 2.6 ± 2.0 mm Hg (P < 0.0001). The absolute difference of ETCO₂ and PaCO₂ was 5 or less in 47 of 82 measurements, whereas the absolute TCCO₂ to PaCO₂ difference was 5 or less in 76 of 82 measurements (P < 0.00001). Regression analysis of ETCO₂ and PaCO₂ values revealed a correlation coefficient of 0.5418 and an r value of 0.8745. Regression analysis of TCCO₂ and PaCO₂ values revealed a correlation coefficient of 1.0160 and an r value of 0.9693. Bland-Altman analysis revealed a bias of -5.68 with a precision of ±6.93 when comparing ETCO₂ with PaCO₂ and a bias of 0.02 with a precision of ±3.27 when comparing TCCO₂ and PaCO₂ (P < 0.00001). TCCO₂ monitoring provided an accurate estimation of PaCO₂ over a wide range of CO₂ values and was superior to ETCO₂ monitoring in older pediatric patients with respiratory failure. TCCO₂ monitoring may be considered as a useful adjunct to monitoring of ventilation in this patient population.

Implications: The authors report on the accuracy of noninvasive, transcutaneous CO₂ monitoring during mechanical ventilation in children 4 yr or older. Application of this technique should be useful by decreasing the need for repeated, costly, and sometimes painful arterial blood gas analysis, and the continuity of assessment should facilitate proactive, rather than reactive, ventilator manipulations.

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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