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Arterial to end-tidal carbon dioxide difference in children undergoing mechanical ventilation of the lungs during general anaesthesia.

  • Onodi C Department of Anaesthesia and Children's Research Centre, University Children's Hospital, Zurich, Switzerland.
  • Bühler PK Department of Anaesthesia and Children's Research Centre, University Children's Hospital, Zurich, Switzerland.
  • Thomas J Department of Anaesthesia and Children's Research Centre, University Children's Hospital, Zurich, Switzerland.
  • Schmitz A Department of Anaesthesia and Children's Research Centre, University Children's Hospital, Zurich, Switzerland.
  • Weiss M Department of Anaesthesia and Children's Research Centre, University Children's Hospital, Zurich, Switzerland.
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  • 2017-07-12
Published in:
  • Anaesthesia. - 2017
carbon dioxide
end-tidal carbon dioxide
equipment
monitoring
paediatrics
ventilation
Adolescent
Anesthesia, General
Blood Gas Analysis
Capnography
Carbon Dioxide
Catheters, Indwelling
Child
Child, Preschool
Female
Humans
Infant
Male
Monitoring, Intraoperative
Respiration, Artificial
Retrospective Studies
Spirometry
English Capnography (ETCO2 ) is routinely used as a non-invasive estimate of arterial carbon dioxide (PaCO2 ) levels in order to modify ventilatory settings, whereby it is assumed that there is a positive gap between PaCO2 and ETCO2 of approximately 0.5 kPa. However, negative values (ETCO2 > PaCO2 ) can be observed. We retrospectively analysed arterial to end-tidal carbon dioxide differences in 799 children undergoing general anaesthesia with mechanical ventilation of the lungs in order to elucidate predictors for a negative gap. A total of 2452 blood gas analysis readings with complete vital sign monitoring, anaesthesia gas analysis and spirometry data were analysed. Mean arterial to end-tidal carbon dioxide difference was -0.18 kPa (limits of 95% agreement -1.10 to 0.74) and 71.2% of samples demonstrated negative values. The intercept model revealed PaCO2 to be the strongest predictor for a negative PaCO2 -ETCO2 difference. A decrease in PaCO2 by 1 kPa resulted in a decrease in the PaCO2 -ETCO2 difference by 0.23 kPa. This study demonstrates that ETCO2 monitoring in children whose lungs are mechanically ventilated may paradoxically lead to overestimation of ETCO2 (ETCO2 > PaCO2 ) with a subsequent risk of unrecognised hypocarbia.
Language
  • English
Open access status
bronze
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Persistent URL
https://sonar.rero.ch/global/documents/24207
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