Application of Transcutaneous Carbon Dioxide Tension Monitoring with Low Electrode Temperatures in Premature Infants in the Early Postnatal Period

Katsuya Hirata; Masahiro Nishihara; Yukari Oshima; Shinya Hirano; Hiroyuki Kitajima

doi:10.1055/s-0033-1352485

American Journal of Perinatology, Table of Contents

Am J Perinatol 2014; 31(05): 435-440
DOI: 10.1055/s-0033-1352485

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Application of Transcutaneous Carbon Dioxide Tension Monitoring with Low Electrode Temperatures in Premature Infants in the Early Postnatal Period

Authors

Katsuya Hirata

¹Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
Masahiro Nishihara

¹Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
Yukari Oshima

¹Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
Shinya Hirano

¹Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
Hiroyuki Kitajima

¹Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan

Abstract

Objective The aim of this article is to evaluate the accuracy, precision, and safety of transcutaneous carbon dioxide tension (TcPCO₂) monitoring at different electrode temperatures in preterm infants in the early postnatal period.

Study Design A total of 26 neonates with a median birth weight of 974 g (432–1,694 g) and gestational age of 28.0 weeks (26.1–31.3 weeks) were studied in the first 5 days of life. A total of 252 simultaneous pairs (TcPCO₂ and arterial carbon dioxide tension [PaCO₂]) were analyzed at 38, 39, and 40°C at 26 and 27 weeks, and at 38, 39, 40, and 42°C at 28 to 31 weeks.

Results The mean difference of TcPCO₂ and PaCO₂ (bias) increased from 3.93 mm Hg at 42°C to 5.64 mm Hg at 40°C, 6.58 mm Hg at 39°C, and 6.07 mm Hg at 38°C. Standard deviation (SD) of the bias increased from 4.17 mm Hg at 42°C to 4.76 mm Hg at 40°C, 5.29 mm Hg at 39°C, and 5.07 mm Hg at 38°C. Adverse skin lesions were not observed.

Conclusion TcPCO₂ measurements are the most accurate and precise at an electrode temperature of 42°C. However, in premature babies, monitoring at 38, 39, and 40°C is possible provided a bias correction of 6 mm Hg and SD of 5 mm Hg are applied.

Keywords

carbon dioxide - electrode temperature - arterial blood sampling - premature infant - newborn

Full Text

References

References
1 Shankaran S, Langer JC, Kazzi SN, Laptook AR, Walsh M ; National Institute of Child Health and Human Development Neonatal Research Network. Cumulative index of exposure to hypocarbia and hyperoxia as risk factors for periventricular leukomalacia in low birth weight infants. Pediatrics 2006; 118 (4) 1654-1659
2 Hatzidaki E, Giahnakis E, Maraka S , et al. Risk factors for periventricular leukomalacia. Acta Obstet Gynecol Scand 2009; 88 (1) 110-115
3 Kaiser JR, Gauss CH, Pont MM, Williams DK. Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants. J Perinatol 2006; 26 (5) 279-285
4 McKee LA, Fabres J, Howard G, Peralta-Carcelen M, Carlo WA, Ambalavanan N. PaCO2 and neurodevelopment in extremely low birth weight infants. J Pediatr 2009; 155 (2) 217-221 , e1
5 Restrepo RD, Hirst KR, Wittnebel L, Wettstein R. AARC clinical practice guideline: transcutaneous monitoring of carbon dioxide and oxygen: 2012. Respir Care 2012; 57 (11) 1955-1962
6 Molloy EJ, Deakins K. Are carbon dioxide detectors useful in neonates?. Arch Dis Child Fetal Neonatal Ed 2006; 91 (4) F295-F298
7 Sørensen LC, Brage-Andersen L, Greisen G. Effects of the transcutaneous electrode temperature on the accuracy of transcutaneous carbon dioxide tension. Scand J Clin Lab Invest 2011; 71 (7) 548-552
8 Binder N, Atherton H, Thorkelsson T, Hoath SB. Measurement of transcutaneous carbon dioxide in low birthweight infants during the first two weeks of life. Am J Perinatol 1994; 11 (3) 237-241
9 Herrell N, Martin RJ, Pultusker M, Lough M, Fanaroff A. Optimal temperature for the measurement of transcutaneous carbon dioxide tension in the neonate. J Pediatr 1980; 97 (1) 114-117
10 Nishiyama T, Nakamura S, Yamashita K. Effects of the electrode temperature of a new monitor, TCM4, on the measurement of transcutaneous oxygen and carbon dioxide tension. J Anesth 2006; 20 (4) 331-334
11 Friis-Hansen B, Voldsgaard P, Witt J, Pedersen KG, Frederiksen PS. The measurement of TcPO2 and TcPCO2 in newborn infants at 44 degrees C, 42 degrees C and 37 degrees C after initial heating to 44 degrees C. Adv Exp Med Biol 1987; 220: 35-40
12 Aliwalas LL, Noble L, Nesbitt K, Fallah S, Shah V, Shah PS. Agreement of carbon dioxide levels measured by arterial, transcutaneous and end tidal methods in preterm infants < or = 28 weeks gestation. J Perinatol 2005; 25 (1) 26-29
13 Eberhard P. The design, use, and results of transcutaneous carbon dioxide analysis: current and future directions. Anesth Analg 2007; 105 (6, Suppl): S48-S52
14 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1 (8476) 307-310
15 Sivan Y, Eldadah MK, Cheah TE, Newth CJ. Estimation of arterial carbon dioxide by end-tidal and transcutaneous PCO2 measurements in ventilated children. Pediatr Pulmonol 1992; 12 (3) 153-157
16 Steveringhaus JW. Transcutaneous blood gas analysis. Respir Care 1982; 27: 152-159
17 Siggaard-Andersen O. The Acid-Base Status of the Blood, 3rd ed. Baltimore: Williams & Wilkins Co; 1965: 85
18 Martin RJ, Beoglos A, Miller MJ, DiFiore JM, Robertson SS, Carlo WA. Increasing arterial carbon dioxide tension: influence on transcutaneous carbon dioxide tension measurements. Pediatrics 1988; 81 (5) 684-687