Accuracy of a Novel Transcutaneous PCO₂ and PO₂ Sensor with Optical PO₂ Measurement in Neonatal Intensive Care: A Single-Centre Prospective Clinical Trial

Abstract

<b><i>Background and Objectives:</i></b> Transcutaneous PCO<sub>2</sub> and PO<sub>2</sub> measurement systems offer non-invasive blood gas trend monitoring. The aim of this prospective study was to assess bias and precision of a transcutaneous PCO<sub>2</sub> and PO<sub>2</sub> measurement system incorporating a novel pO<sub>2</sub> sensor (Sentec OxiVenT™) in neonates ≥34 weeks of gestational age (GA) admitted to intensive care. <b><i>Methods:</i></b> Transcutaneous PCO<sub>2</sub> and PO<sub>2</sub> were compared to arterial and capillary blood gas measurements. Bias and precision were calculated by fitting linear mixed models to account for repeated measurements, and influence of clinical covariates on bias and precision was assessed. <b><i>Results:</i></b> We obtained 611 paired transcutaneous and blood gas measurements in 110 patients (median GA 38.3 [interquartile range 36.1–39.7] weeks; age 9 [4–15] days; weight 3,000 [2,500–3,500] g). Transcutaneous PCO<sub>2</sub> showed significant bias to arterial PCO<sub>2</sub> (+0.61; 95% confidence interval 0.46, 0.76 kPa), but not to capillary PCO<sub>2</sub> (−0.23; −0.46, 0.002 kPa). Bias of transcutaneous PO<sub>2</sub> was significant to arterial PO<sub>2</sub> (−2.50; −2.94, −2.06 kPa), while no significant bias compared to capillary PO<sub>2</sub> was observed (+0.17; −0.30, 0.64 kPa). Precision intervals were ±1.8/2.0 kPa for arterial versus capillary PCO<sub>2</sub> and ±4.9/3.3 kPa for arterial versus capillary PO<sub>2</sub> comparisons, respectively. Further, sensor operating temperature (43°C vs. 42°C), soft tissue oedema, vasoactive drugs, weight, and GA significantly altered bias (<i>p</i> < 0.05). <b><i>Conclusions:</i></b> The tested transcutaneous blood gas measurement system showed no significant bias compared to capillary PCO<sub>2</sub> and PO<sub>2</sub>, acceptable bias to arterial PCO<sub>2</sub>, and limited agreement with arterial PO<sub>2</sub>. Precision intervals were wide for all comparisons.

Transcutaneous CO2 Monitoring in Extremely Low Birth Weight Premature Infants

“…Other studies found that the sampling method or mode of ventilation could affect the accuracy of TcCO 2 measurements. For example, Mukhopadhyay et al found that HFOV support significantly increases the odds of increased bias [20], and others found that tcCO 2 was more accurate for capillary blood samples than for arterial blood samples [16,20,27]. In our study, 84% of the samples were within an absolute range of ±10 mmHg.…”

Use of the EIS (Electrical Impedance Segmentography System) in Less-Invasive Surfactant Administration (LISA) in New-Borns Suffering from Respiratory Failure

“…Respiratory failure can cause decreased tidal volume and Functional Residual Capacity (FRC) and requires respiratory assistance. Chest X-Ray, respiratory function monitors, transcutaneous blood gas monitoring, capnography and blood gas analysis are the most used tools to understand the evolution of the respiratory picture of new-borns at NICU [15,16]. In studies and in clinical practice, monitoring of respiratory function in new-borns admitted in the neonatal intensive care units uses various radiation-free imaging technologies [15,17], including lung ultrasound [2,18], electrical impedance tomography (EIT) [19][20][21][22], and segmentography (EIS) [5].…”

A Novel Noninvasive Technology for Real-Time Assessment of Critical Blood Values: A Pilot Clinical Study

“…The accuracy of these algorithms may vary depending on the patient physiology, the device used, and the environment. [13] The accuracy of the transcutaneous non-invasive measurements can be affected by several factors including skin perfusion, skin condition, patient movement, temperature, environmental factors, and potentially other health conditions of the patient [6,14,15]. Since these devices rely on the diffusion of oxygen and carbon dioxide through the skin, poor skin perfusion will not allow accurate measurements [16].…”