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Arterial to end‐tidal carbon dioxide difference in children undergoing mechanical ventilation of the lungs during general anaesthesia

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Zeitschriftentitel: Anaesthesia
Personen und Körperschaften: Onodi, C., Bühler, P. K., Thomas, J., Schmitz, A., Weiss, M.
In: Anaesthesia, 72, 2017, 11, S. 1357-1364
Format: E-Article
Sprache: Englisch
veröffentlicht:
Wiley
Schlagwörter:
Anesthesiology and Pain Medicine
Details
Zusammenfassung: <jats:title>Summary</jats:title><jats:p>Capnography (ET<jats:styled-content style="fixed-case">CO</jats:styled-content><jats:sub>2</jats:sub>) is routinely used as a non‐invasive estimate of arterial carbon dioxide (Pa<jats:styled-content style="fixed-case">CO</jats:styled-content><jats:sub>2</jats:sub>) levels in order to modify ventilatory settings, whereby it is assumed that there is a positive gap between Pa<jats:styled-content style="fixed-case">CO</jats:styled-content><jats:sub>2</jats:sub> and ET<jats:styled-content style="fixed-case">CO</jats:styled-content><jats:sub>2</jats:sub> of approximately 0.5 <jats:styled-content style="fixed-case">kP</jats:styled-content>a. However, negative values (ET<jats:styled-content style="fixed-case">CO</jats:styled-content><jats:sub>2</jats:sub> &gt; Pa<jats:styled-content style="fixed-case">CO</jats:styled-content><jats:sub>2</jats:sub>) can be observed. We retrospectively analysed arterial to end‐tidal carbon dioxide differences in 799 children undergoing general anaesthesia with mechanical ventilation of the lungs in order to elucidate predictors for a negative gap. A total of 2452 blood gas analysis readings with complete vital sign monitoring, anaesthesia gas analysis and spirometry data were analysed. Mean arterial to end‐tidal carbon dioxide difference was −0.18 <jats:styled-content style="fixed-case">kP</jats:styled-content>a (limits of 95% agreement −1.10 to 0.74) and 71.2% of samples demonstrated negative values. The intercept model revealed Pa<jats:styled-content style="fixed-case">CO</jats:styled-content><jats:sub>2</jats:sub> to be the strongest predictor for a negative Pa<jats:styled-content style="fixed-case">CO</jats:styled-content><jats:sub>2</jats:sub>‐ET<jats:styled-content style="fixed-case">CO</jats:styled-content><jats:sub>2</jats:sub> difference. A decrease in Pa<jats:styled-content style="fixed-case">CO</jats:styled-content><jats:sub>2</jats:sub> by 1 <jats:styled-content style="fixed-case">kP</jats:styled-content>a resulted in a decrease in the Pa<jats:styled-content style="fixed-case">CO</jats:styled-content><jats:sub>2</jats:sub>‐ET<jats:styled-content style="fixed-case">CO</jats:styled-content><jats:sub>2</jats:sub> difference by 0.23 <jats:styled-content style="fixed-case">kP</jats:styled-content>a. This study demonstrates that ET<jats:styled-content style="fixed-case">CO</jats:styled-content><jats:sub>2</jats:sub> monitoring in children whose lungs are mechanically ventilated may paradoxically lead to overestimation of ET<jats:styled-content style="fixed-case">CO</jats:styled-content><jats:sub>2</jats:sub> (ET<jats:styled-content style="fixed-case">CO</jats:styled-content><jats:sub>2</jats:sub> &gt; Pa<jats:styled-content style="fixed-case">CO</jats:styled-content><jats:sub>2</jats:sub>) with a subsequent risk of unrecognised hypocarbia.</jats:p>
Umfang: 1357-1364
ISSN: 0003-2409
1365-2044
DOI: 10.1111/anae.13969