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• W2894528493 abstract "<h3>BACKGROUND:</h3> Widespread use of transcutaneous P_CO₂ (P_tcCO₂) monitoring is currently limited by concerns many practitioners have regarding accuracy. We compared the accuracy of P_tcCO₂ with that of P_aCO₂ measurements in critically ill children, and we investigated whether clinical conditions associated with low cardiac output or increased subcutaneous tissue affect this accuracy. <h3>METHODS:</h3> We performed a single-center prospective study of critically ill children placed on transcutaneous monitoring. <h3>RESULTS:</h3> There were 184 children enrolled with paired P_aCO₂ and P_tcCO₂ values. Subjects had a median age of 31.8 mo (interquartile range 3.5–123.3 mo). Most children were mechanically ventilated (<i>n</i> = 161, 87.5%), and many had cardiac disease (<i>n</i> = 76, 41.3%). The median P_aCO₂ was 44 mm Hg (interquartile range 39–51 mm Hg). The mean bias between P_aCO₂ and P_tcCO₂ was 0.6 mm Hg with 95% limits of agreement from −13.6 to 14.7 mm Hg. The P_tcCO₂ and P_aCO₂ were within ±5 mm Hg in 126 (68.5%) measurements. In multivariable modeling, cyanotic heart disease (odds ratio 3.5, 95% CI 1.2–10, <i>P</i> = .02) and monitor number 2 (odds ratio 3.8 95% CI 1.3–10.5, <i>P</i> = .01) remained associated with P_tcCO₂ ≥ 5 mm Hg higher than P_aCO₂. Serum lactate, fluid balance, renal failure, obesity, vasoactive-inotrope score, and acyanotic heart disease were not associated with high or low P_tcCO₂ values. In 130 children with a second paired P_tcCO₂ and P_aCO₂ measurement, predicting the second measured P_aCO₂ by subtracting the initial observed difference between the P_tcCO₂ and P_aCO₂ from the subsequent measured P_tcCO₂ decreased the mean bias between observed and predicted P_aCO₂ to 0.2 mm Hg and the 95% limits of agreement to −9.4 to 9.7 mm Hg. <h3>CONCLUSIONS:</h3> P_tcCO₂ provides an acceptable estimate of P_aCO₂ in many critically ill children, including those with clinical conditions that may be associated with low cardiac output or increased subcutaneous tissue, although it does not perform as well in children with cyanotic heart disease. P_tcCO₂ may be a useful adjunct monitoring method, but it cannot reliably replace P_aCO₂ measurement." @default.
• W2894528493 created "2018-10-05" @default.
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• W2894528493 date "2018-09-25" @default.
• W2894528493 modified "2023-09-27" @default.
• W2894528493 title "Accuracy of Transcutaneous Carbon Dioxide Levels in Comparison to Arterial Carbon Dioxide Levels in Critically Ill Children" @default.
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• W2894528493 doi "https://doi.org/10.4187/respcare.06209" @default.
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