Agreement of Carbon Dioxide Levels Measured by Arterial, Transcutaneous and End Tidal Methods in Preterm Infants ≤28 Weeks Gestation

Abstract

A moderate agreement with a wide variation in individual values was observed between noninvasive methods and PaCO(2) in preterm infants in the first 24 hours. Noninvasive monitoring methods cannot be substituted for PaCO(2) analyses in preterm infants during this critical period.

Neonatal Transcutaneous Carbon Dioxide Monitoring—Effect on Clinical Management and Outcomes

“…7,8 However, there are reasons to be concerned about the impact of P tcCO 2 monitoring in the course of standard NICU clinical care. Wide agreement between P tcCO 2 and arterial blood gas has been reported in the preterm population. 2 Many NICU infants remain intubated for long duration with evolving physiological states of cardiac output and fluctuating P CO 2 values that may alter P tcCO 2 agreement.…”

“…Wide agreement between P tcCO 2 and arterial blood gas has been reported in the preterm population. 2 Many NICU infants remain intubated for long duration with evolving physiological states of cardiac output and fluctuating P CO 2 values that may alter P tcCO 2 agreement. 9,10 Further, many blood gas samples used in the NICU are capillary samples, and reports to date have correlated P tcCO 2 with arterial or venous samples.…”

“…To account for selection bias, we compared the demographics and clinical characteristics of neonates excluded with those of neonates included and found that P tcCO 2 …”

“…9,10 Further, many blood gas samples used in the NICU are capillary samples, and reports to date have correlated P tcCO 2 with arterial or venous samples. 2,7,11 Although the American Association for Respiratory Care recognized the use of P tcCO 2 values in specific clinical situations, their statement noted that a hazard of P tcCO 2 use is "misinterpretation of falsely elevated or decreased values leading to inappropriate treatment of the patient." 12 Such false alarms could potentially lead to increased blood draws instead of reducing them or cause unnecessary ventilator manipulation and negatively affect outcomes.…”

“…Transcutaneous carbon-dioxide monitors use heated skin sensors that increase blood flow through the cutaneous capillary system. The locally produced P CO 2 is then measured electrochemically and adjusted to provide an output reflective of the arterial blood P CO 2 . This transcutaneously measure carbon-di-oxide (P tcCO 2 ) has been studied in selected groups of infants for short periods of time, demonstrating good agreement with arterial blood P CO 2 .…”