End‐Tidal Carbon Dioxide Monitoring in Neonates Receiving Therapeutic Hypothermia for Hypoxic‐Ischemic Encephalopathy
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2025
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| author | Mate Detar Barbara Szasz Hajnalka Barta Miklos Szabo Agnes Jermendy Eniko Szakmar |
| author_facet | Mate Detar Barbara Szasz Hajnalka Barta Miklos Szabo Agnes Jermendy Eniko Szakmar Mate Detar Barbara Szasz Hajnalka Barta Miklos Szabo Agnes Jermendy Eniko Szakmar |
| collection | Wiley Open Access |
| contents | End‐Tidal Carbon Dioxide Monitoring in Neonates Receiving Therapeutic Hypothermia for Hypoxic‐Ischemic Encephalopathy Mate Detar Barbara Szasz Hajnalka Barta Miklos Szabo Agnes Jermendy Eniko Szakmar Pediatric Pulmonology ABSTRACT Introduction Primary aim was to assess the agreement between end‐tidal carbon dioxide (etCO 2 ) monitoring and arterial, capillary and venous PCO 2 values in mechanically ventilated patients receiving therapeutic hypothermia (TH) for hypoxic‐ischemic encephalopathy (HIE). Secondary, to assess the percentage of time spent in predefined PCO 2 ranges based on continuous etCO 2 monitoring. Methods In this prospective observational single center trial, infants with moderate‐to‐severe HIE receiving conventional ventilation with sidestream capnography were enrolled. Blood gas measurements were performed based on clinical indication. The mean of 12,000 etCO 2 values obtained over 10 min before each corresponding blood gas was used for analysis. The agreement between mean etCO 2 and temperature corrected and uncorrected PCO 2 at 37 ◦ C were analyzed using Bland‐Altman (BA) plots. Results A total of 262 paired PCO 2 and etCO 2 values were analyzed from 35 patients. The bias between temperature corrected arterial PCO 2 and etCO 2 ( n = 116) was 1.87 mmHg (SD 5.54) with −8.99 and 12.73 limits of agreement; whereas the bias between capillary PCO 2 and etCO 2 ( n = 132) was 7.22 mmHg (SD 6.08). EtCO 2 underestimated PCO 2 of any source at 37°C. Excluding patients with lung diseases from BA analysis did not show improvement in the agreement. Infants spent median 23.9% [IQR 8.5; 36.7] of monitoring time in etCO 2 range < 35 mmHg and median 75.0% [IQR 61.1; 87.7] in etCO 2 range of 35‐55 mmHg. Conclusions EtCO 2 monitoring may be a valuable addition to neurocritical care of infants with HIE as it showed a strong level of agreement with temperature corrected arterial PCO 2 . 10.1002/ppul.71144 http://creativecommons.org/licenses/by-nc/4.0/ |
| doi_str_mv | 10.1002/ppul.71144 |
| format | Artículo Open Access |
| id | wiley_oa_10_1002_ppul_71144 |
| institution | Wiley Open Access |
| license_str_mv | http://creativecommons.org/licenses/by-nc/4.0/ |
| publishDate | 2025 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | End‐Tidal Carbon Dioxide Monitoring in Neonates Receiving Therapeutic Hypothermia for Hypoxic‐Ischemic Encephalopathy Mate Detar Barbara Szasz Hajnalka Barta Miklos Szabo Agnes Jermendy Eniko Szakmar Pediatric Pulmonology End‐Tidal Carbon Dioxide Monitoring in Neonates Receiving Therapeutic Hypothermia for Hypoxic‐Ischemic Encephalopathy Mate Detar Barbara Szasz Hajnalka Barta Miklos Szabo Agnes Jermendy Eniko Szakmar Pediatric Pulmonology ABSTRACT Introduction Primary aim was to assess the agreement between end‐tidal carbon dioxide (etCO 2 ) monitoring and arterial, capillary and venous PCO 2 values in mechanically ventilated patients receiving therapeutic hypothermia (TH) for hypoxic‐ischemic encephalopathy (HIE). Secondary, to assess the percentage of time spent in predefined PCO 2 ranges based on continuous etCO 2 monitoring. Methods In this prospective observational single center trial, infants with moderate‐to‐severe HIE receiving conventional ventilation with sidestream capnography were enrolled. Blood gas measurements were performed based on clinical indication. The mean of 12,000 etCO 2 values obtained over 10 min before each corresponding blood gas was used for analysis. The agreement between mean etCO 2 and temperature corrected and uncorrected PCO 2 at 37 ◦ C were analyzed using Bland‐Altman (BA) plots. Results A total of 262 paired PCO 2 and etCO 2 values were analyzed from 35 patients. The bias between temperature corrected arterial PCO 2 and etCO 2 ( n = 116) was 1.87 mmHg (SD 5.54) with −8.99 and 12.73 limits of agreement; whereas the bias between capillary PCO 2 and etCO 2 ( n = 132) was 7.22 mmHg (SD 6.08). EtCO 2 underestimated PCO 2 of any source at 37°C. Excluding patients with lung diseases from BA analysis did not show improvement in the agreement. Infants spent median 23.9% [IQR 8.5; 36.7] of monitoring time in etCO 2 range < 35 mmHg and median 75.0% [IQR 61.1; 87.7] in etCO 2 range of 35‐55 mmHg. Conclusions EtCO 2 monitoring may be a valuable addition to neurocritical care of infants with HIE as it showed a strong level of agreement with temperature corrected arterial PCO 2 . 10.1002/ppul.71144 http://creativecommons.org/licenses/by-nc/4.0/ |
| title | End‐Tidal Carbon Dioxide Monitoring in Neonates Receiving Therapeutic Hypothermia for Hypoxic‐Ischemic Encephalopathy |
| topic | Pediatric Pulmonology |
| url | https://onlinelibrary.wiley.com/doi/10.1002/ppul.71144 |