Transcutaneous blood gas monitoring among neonatal intensive care units in Japan

Ochiai, Masayuki; Kurata, Hiroaki; Inoue, Hirosuke; Ichiyama, Masako; Fujiyoshi, Junko; Watabe, Shinichi; Hiroma, Takehiko; Nakamura, Tomohiko; Ohga, Shouichi

doi:10.1111/ped.14107

Cited by 11 publications

(10 citation statements)

References 20 publications

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“…Transcutaneous blood gas monitoring is widely used in neonatal intensive care [1, 2]. It provides a continuous, noninvasive alternative to arterial blood gas sampling for measuring oxygen and carbon dioxide levels.…”

Section: Introductionmentioning

confidence: 99%

Validation of a New Transcutaneous tcPO2/tcPCO2 Sensor with an Optical Oxygen Measurement in Preterm Neonates

et al. 2020

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Introduction: Traditional transcutaneous oxygen (tcPO2) measurements are affected by measurement drift, limiting accuracy and usability. The new potentially drift-free oxygen fluorescence quenching technique has been combined in a single sensor with conventional transcutaneous carbon dioxide (tcPCO2) monitoring. This study aimed to validate optical tcPO2 and conventional tcPCO2 against arterial blood gas samples in preterm neonates and determine measurement drift. Methods: In this prospective observational study, during regular care, transcutaneous measurements were paired to arterial blood gases from preterm neonates aged 24–31 weeks of gestational age (GA) with an arterial catheter. Samples were included based on stability criteria and stratified for sepsis status. Agreement was assessed using the Bland-Altman analysis. Measurement drift per hour was calculated. Results: Sixty-eight premature neonates were included {median (interquartile range [IQR]) GA of 26 4/7 [25 3/7–27 5/7] weeks}, resulting in 216 stable paired samples. Agreement of stable samples in neonates without sepsis (n = 38) and with suspected sepsis (n = 112) was acceptable for tcPO2 and good for tcPCO2. However, in stable samples of neonates with sepsis (n = 66), tcPO2 agreement (bias and 95% limits of agreement) was −32.6 (−97.0 to 31.8) mm Hg and tcPCO2 agreement was 4.2 (−10.5 to 18.9) mm Hg. The median (IQR) absolute drift values were 0.058 (0.0231–0.1013) mm Hg/h for tcPO2 and 0.30 (0.11–0.64) mm Hg/h for tcPCO2. Conclusion: The accuracy of optical tcPO2 in premature neonates was acceptable without sepsis, while electrochemically measured tcPCO2 remained accurate under all circumstances. Measurement drift was negligible for tcPO2 and highly acceptable for tcPCO2.

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Section: Introductionmentioning

confidence: 99%

Validation of a New Transcutaneous tcPO2/tcPCO2 Sensor with an Optical Oxygen Measurement in Preterm Neonates

et al. 2020

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“…1 One infant died before surgical strategy could be determined. 2 Lost data due to change in patient record system. van…”

Section: Sample Selectionmentioning

confidence: 99%

Improving the Clinical Interpretation of Transcutaneous Carbon Dioxide and Oxygen Measurements in the Neonatal Intensive Care Unit

et al. 2023

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Introduction: Transcutaneous blood gas monitoring allows for continuous non-invasive evaluation of carbon dioxide and oxygen levels. Its use is limited as its accuracy is dependent on several factors. We aimed to identify the most influential factors to increase usability and aid in the interpretation of transcutaneous blood gas monitoring. Methods: In this retrospective cohort study, transcutaneous blood gas measurements were paired to arterial blood gas withdrawals in neonates admitted to the neonatal intensive care unit. The effects of patient-related, microcirculatory, macrocirculatory, respiratory, and sensor-related factors on the difference between transcutaneously and arterially measured carbon dioxide and oxygen values (ΔPCO2 and ΔPO2) were evaluated using marginal models. Results: A total of 1,578 measurement pairs from 204 infants with a median [interquartile range] gestational age of 273/7 [261/7–313/7] weeks were included. ΔPCO2 was significantly associated with the postnatal age, arterial systolic blood pressure, body temperature, arterial partial pressure of oxygen (PaO2), and sensor temperature. ΔPO2 was, with the exception of PaO2, additionally associated with gestational age, birth weight Z-score, heating power, arterial partial pressure of carbon dioxide, and interactions between sepsis and body temperature and sepsis and the fraction of inspired oxygen. Conclusion: The reliability of transcutaneous blood gas measurements is affected by several clinical factors. Caution is recommended when interpreting transcutaneous blood gas values with an increasing postnatal age due to skin maturation, lower arterial systolic blood pressures, and for transcutaneously measured oxygen values in the case of critical illness.

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“…Transcutaneous blood gas monitoring represents standard of care in neonatal intensive care units [1][2][3][4]. To date, the majority of transcutaneous sensors employ electrochemical measurement principles like oxygen reduction for PO 2 and pH-changes in buffered electrolyte solution for PCO 2 [5,6].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Background and Objectives: Transcutaneous PCO2 and PO2 measurement systems offer non-invasive blood gas trend monitoring. The aim of this prospective study was to assess bias and precision of a transcutaneous PCO2 and PO2 measurement system incorporating a novel pO2 sensor (Sentec OxiVenT™) in neonates ≥34 weeks of gestational age (GA) admitted to intensive care. Methods: Transcutaneous PCO2 and PO2 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. Results: 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 PCO2 showed significant bias to arterial PCO2 (+0.61; 95% confidence interval 0.46, 0.76 kPa), but not to capillary PCO2 (−0.23; −0.46, 0.002 kPa). Bias of transcutaneous PO2 was significant to arterial PO2 (−2.50; −2.94, −2.06 kPa), while no significant bias compared to capillary PO2 was observed (+0.17; −0.30, 0.64 kPa). Precision intervals were ±1.8/2.0 kPa for arterial versus capillary PCO2 and ±4.9/3.3 kPa for arterial versus capillary PO2 comparisons, respectively. Further, sensor operating temperature (43°C vs. 42°C), soft tissue oedema, vasoactive drugs, weight, and GA significantly altered bias (p < 0.05). Conclusions: The tested transcutaneous blood gas measurement system showed no significant bias compared to capillary PCO2 and PO2, acceptable bias to arterial PCO2, and limited agreement with arterial PO2. Precision intervals were wide for all comparisons.

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Transcutaneous blood gas monitoring among neonatal intensive care units in Japan

Cited by 11 publications

References 20 publications

Validation of a New Transcutaneous tcPO<sub>2</sub>/tcPCO<sub>2</sub> Sensor with an Optical Oxygen Measurement in Preterm Neonates

Validation of a New Transcutaneous tcPO<sub>2</sub>/tcPCO<sub>2</sub> Sensor with an Optical Oxygen Measurement in Preterm Neonates

Improving the Clinical Interpretation of Transcutaneous Carbon Dioxide and Oxygen Measurements in the Neonatal Intensive Care Unit

Accuracy of a Novel Transcutaneous PCO<sub>2</sub> and PO<sub>2</sub> Sensor with Optical PO<sub>2</sub> Measurement in Neonatal Intensive Care: A Single-Centre Prospective Clinical Trial

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