Capillary blood gas in infants with bronchiolitis: Can end-tidal capnography replace it?

Vo, Andrea; Liu, Deborah R.; Schmidt, Anita R.; Festekjian, Ara

doi:10.1016/j.ajem.2021.04.056

Cited by 5 publications

(8 citation statements)

References 37 publications

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“…Our findings were in line with the study by Vo [16] also with regard to other clinical features in children with bronchiolitis. It needs to be emphasized that except for the breath rate on admission (which was higher in patients transferred to the ICU but also correlated with age and in the multiple regression model showed no relationship with the risk of an ICU transfer), there were no differences in any other clinical or laboratory baseline characteristics of children who required an intensive care unit transfer.…”

Section: Discussionsupporting

confidence: 93%

“…A significant association between pCO 2 and respiratory decompensation was shown, and an increased odds ratio was observed (OR = 1.07). We found significantly higher OR for hypercapnia in the prediction of ICU transfer, but a difference between the groups of patients needs to be addressed; while in the research by Vo over 45% of patients decompensated (and the decompensation is almost equal to ICU transfer in our study), in our group of patients the risk of ICU transfer was approximately 3% (15 out of 485 patients) [16]. The differences between the groups seem to be striking, however, the usefulness of the CBG-pCO 2 is similar; moreover, the differences may explain different cutoff values.…”

Section: Discussioncontrasting

confidence: 60%

“…Certainly, the values may vary in other groups, but special alertness should be held in the case of this parameter. A study by Vo analysed pCO 2 in capillary blood gas samples taken at hospital admission from 134 patients with bronchiolitis and found significantly higher mean pCO 2 in the respiratory decompensation group (48 vs. 44 mmHg) [16]. A significant association between pCO 2 and respiratory decompensation was shown, and an increased odds ratio was observed (OR = 1.07).…”

Section: Discussionmentioning

confidence: 99%

“…The differences between the groups seem to be striking, however, the usefulness of the CBG-pCO 2 is similar; moreover, the differences may explain different cutoff values. Furthermore, the question raised by Vo needs to be taken into consideration; a routine blood gas may not be needed in each case of bronchiolitis but may be helpful in the assessment of more severe cases, especially as a part of the more complex evaluation that includes other clinical features [16].…”

Section: Discussionmentioning

confidence: 99%

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Capillary Blood Gas Predicts Risk of Intensive Care in Children with Bronchiolitis

2021

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Background: Bronchiolitis may result in respiratory failure diagnosed with arterial blood gas (ABG). ABG is not routinely performed in general paediatric wards but is closely reflected by capillary blood gas (CBG). We sought to assess the usefulness of CBG results in prediction of intensive care unit (ICU) transfer, antibiotic treatment, and length of stay in children hospitalized due to bronchiolitis. Methods: The optimal cutoff values were estimated with an ROC analysis, while a multiple regression model calculated the odds of an ICU transfer, prolonged hospitalization, and antibiotic treatment related with hypercapnia (pCO2 ≥ 45 mmHg) and acidosis (pH ≤ 7.35). The correlation between the CBG (pH, pCO2, and SatO2) and the clinical/laboratory parameters (breath rate, heart rate, pulse oximetry, white blood cells, CRP, and procalcitonin) was calculated. Results: The CBG was performed in 485 children aged 8 days–22 months (median 2 months). The pCO2 was significantly higher in ICU transferred patients (median 44.8 mmHg vs. 36.2 mmHg, p < 0.01), and showed AUC = 0.773, (95% CI: 0.638–0.907, p < 0.01) for ICU transfer (67% sensitivity, 82% specificity, 10.8% positive and 98.7% negative predictive value at cutoff 41.8 mmHg). Hypercapnia (OR = 6.63, 95% CI: 2.15–20.46, p < 0.01) and acidosis (OR = 5.01, 95% CI: 1.26–19.9, p = 0.022) predicted the ICU transfer independently. The CBG parameters were not related to prolonged hospitalization or antibiotic treatment, and showed only a weak and clinically irrelevant correlation with other laboratory and clinical parameters. Conclusions: Acidosis and hypercapnia indicate patients at risk of an ICU transfer, and the pCO2 levels (including values lower than hypercapnia) seem to be a promising marker in ICU risk assessment.

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Section: Discussionsupporting

confidence: 93%

Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Capillary Blood Gas Predicts Risk of Intensive Care in Children with Bronchiolitis

2021

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“…The first one is the group selection, as patients included in our study (except for one) did not present a respiratory failure, and obviously a lower respiratory tract involvement is not unequivocally related to a respiratory failure. Promising results of pCO 2 and pH use in the prediction of an ICU transfer were observed in children with bronchiolitis [ 28 , 29 ], but not in this group of influenza hospitalizations. In fact, influenza LRTIs may affect oxygen supply to a higher degree than carbon dioxide elimination or acid-base balance.…”

Section: Discussionmentioning

confidence: 99%

Capillary Blood Gas in Children Hospitalized Due to Influenza Predicts the Risk of Lower Respiratory Tract Infection

Wrotek

Jackowska

2022

Diagnostics

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Background: Influenza may impair respiratory exchange in the case of lower respiratory tract infections (LRTIs). Capillary blood gas (CBG) reflects arterial blood values but is a less invasive method than arterial blood sampling. We aimed to retrospectively verify the usefulness of CBG in pediatric influenza. Material and methods: CBG parameters (pH, pCO2, pO2, SatO2) in laboratory confirmed influenza cases hospitalized in 2013–2020 were verified in terms of LRTI, chest X-ray (CXR) performance, radiologically confirmed pneumonia (CXR + Pneumonia), prolonged hospitalization, and intensive care transfer. A theoretical CBG-based model for CXR performance was created and the odds ratios were compared to the factual CXR performance. Results: Among 409 children (aged 13 days–17 years 3/12, median 31 months), the usefulness of CBG decreased with the age. The SatO2 predicted the LRTI with AUC = 0.74 (95%CI: 0.62–0.86), AUC = 0.71 (0.61–0.82), and AUC = 0.602 (0.502–0.702) in children aged <6 months old (mo), 6–23 mo, 24–59 mo, respectively, while pO2 revealed AUC = 0.73 (0.6–0.85), AUC = 0.67 (0.56–0.78), and AUC = 0.601 (0.501–0.702), respectively. The pCO2 predicted the LRTI most precisely in children <6 months with AUC = 0.75 (0.63–0.87), yet not in older children. A high negative predictive value for CXR + Pneumonia was seen for SatO2 < 6 mo (96.7%), SatO2 6–23 mo (89.6%), pO2 < 6 mo (94.3%), pO2 6–23 mo (88.9%). The use of a CBG-driven CXR protocol (based on SatO2 and pO2) would decrease the odds of an unnecessary CXR in children < 2 years old (yo) by 84.15% (74.5–90.14%) and 86.15% (66.46–94.28%), respectively. SatO2 and pO2 also predicted a prolonged hospitalization < 6 mo AUC = 0.71 (0.59–0.83) and AUC = 0.73 (0.61–0.84), respectively, and in 6–23 mo AUC = 0.66 (0.54–0.78) and AUC = 0.63 (0.52–0.75), respectively. Conclusions: The CBG is useful mainly in children under two years, predicts the risk of LRTI, and can help exclude the risk of CXR + pneumonia. Children under six months of age represent the group that would benefit the most from CBG. A CBG-based protocol for the performance of CXR could significantly decrease the number of unnecessary CXRs.

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Bias between capnometry and venous carbon dioxide during initial assessment of pediatric emergency department patients: A video‐based study

Stratton,

Overmann,

Zhang

et al. 2024

JACEP Open

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ObjectiveThe bias of capnometry (ETCO2) and venous carbon dioxide (vpCO2) among pediatric emergency department (PED) patients triaged to critical care areas is unknown. We aimed to explore correlations and bias between ETCO2 and vpCO2¸and identify predictors of bias.MethodsThis was an observational, video‐based, retrospective study comparing ETCO2 and vpCO2. Pediatric patients with simultaneous ETCO2 and vpCO2 data were included. Our primary aim utilized linear regressions to determine correlations and Bland–Altman analysis to assess bias. Our secondary aim utilized multiple regression to identify clinical covariates contributing to bias. Covariates included age, respiratory rate, heart rate, mean arterial blood pressure, capnometry interface, PED diagnosis, and PED disposition.ResultsA total of 200 PED patients with ETCO2 and vpCO2 data were included. The median (interquartile range [IQR]) ETCO2, vpCO2, and ΔCO2 in mmHg were 38 (32, 46), 49 (41, 61), and 11 (4, 20), respectively. ETCO2 (r = 0.76) and ΔCO2 (r = 0.71) were highly correlated with vpCO2. The mean bias between ETCO2 and vpCO2 was −14.1 mmHg (95% confidence interval [CI], −41.9 −13.7). The bias between ETCO2 and vpCO2 increased at higher values of each measure. ETCO2 sampling interface was the only independent predictor of vpCO2 in our multivariate analysis. Patients requiring bag‐valve mask (BVM) ventilation had the highest median bias between ETCO2 and vpCO2 (29 mmHg, IQR 15, 37).ConclusionETCO2 and vpCO2 were highly correlated. However, bias increased at higher levels of both ETCO2 and vpCO2. Among PED patients, ETCO2’s ability to approximate vpCO2 diminishes with worsening hypercarbic respiratory failure.

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Capillary blood gas in infants with bronchiolitis: Can end-tidal capnography replace it?

Cited by 5 publications

References 37 publications

Capillary Blood Gas Predicts Risk of Intensive Care in Children with Bronchiolitis

Capillary Blood Gas Predicts Risk of Intensive Care in Children with Bronchiolitis

Capillary Blood Gas in Children Hospitalized Due to Influenza Predicts the Risk of Lower Respiratory Tract Infection

Bias between capnometry and venous carbon dioxide during initial assessment of pediatric emergency department patients: A video‐based study

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