The clinical application of transcutaneous carbon dioxide monitoring during rigid bronchoscopy or microlaryngeal surgery in children

IF 5 2区医学 Q1 ANESTHESIOLOGY Journal of Clinical Anesthesia Pub Date : 2024-11-23 DOI:10.1016/j.jclinane.2024.111692

Jan J. van Wijk M.D. , Norani H. Gangaram-Panday M.D. , Willem van Weteringen M.D. , Bas Pullens M.D., Ph.D , Simone E. Bernard M.D. , Sanne E. Hoeks Ph.D , Irwin K.M. Reiss M.D., Ph.D , Robert J. Stolker M.D., Ph.D , Lonneke M. Staals M.D., Ph.D

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Abstract

Study objective

During rigid bronchoscopies and microlaryngeal surgery (MLS) in children, there is currently no reliable method for managing ventilation strategies based on carbon dioxide (CO₂) levels. This study aimed to investigate the effects of the clinical implementation of transcutaneous CO₂ (tcPCO₂) monitoring during rigid bronchoscopies or MLS.

Design

Prospective observational study.

Setting

Operating theatre of a tertiary pediatric hospital, from January 2019 to March 2021.

Patients

Children with an age < 18 years, undergoing rigid bronchoscopy or MLS, were eligible for inclusion. Children with tracheostomy and/or skin conditions limiting tcPCO₂ monitoring were excluded.

Interventions

TcPCO₂ monitoring was performed in two groups; blinded before clinical implementation (control group) and visible for ventilation management after clinical implementation (tcPCO₂ group).

Measurements

The total tcPCO₂ load outside of the normal range (35–48 mm Hg) was calculated as the area under the curve (AUC) and compared between the groups. Anesthesiologists in the tcPCO₂ group received a questionnaire after each procedure.

Main results

A total of 120 patients were included. No significant differences were found between the two groups in the AUC during the procedure (19,202 (7,863–44,944) vs 17,737 (9,800–47,566) mm Hg · s, P = 0.84) or between different ventilation strategies. The maximal tcPCO₂ level was 69.2 (62.1–81.2) mm Hg in the control group and 71.1 (62.8–80.8) mm Hg, (P = 0.85) in the tcPCO₂ group. Spontaneous breathing was associated with lower tcPCO₂ levels. The general satisfaction score of tcPCO₂ monitoring rated by the anesthesiologist was 8.19 (0.96).

Conclusions

TcPCO₂ levels reached approximately twice the upper limit of the normal range during rigid bronchoscopy and MLS. Availability of tcPCO₂ monitoring did not affect these high levels, despite adjustments in strategy. However, tcPCO₂ monitoring provides valuable insight in CO₂ load and applied ventilation strategies.

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儿童硬质支气管镜或喉显微手术期间经皮二氧化碳监测的临床应用

研究目的在对儿童进行硬质支气管镜检查和喉显微手术（MLS）时，目前还没有可靠的方法根据二氧化碳（CO2）水平来管理通气策略。本研究旨在探讨在硬质支气管镜或 MLS 期间临床实施经皮二氧化碳（tcPCO2）监测的效果。干预措施tcPCO2监测分两组进行：临床实施前盲法组（对照组）和临床实施后可见通气管理组（tcPCO2组）。测量超出正常范围（35-48毫米汞柱）的总tcPCO2负荷计算为曲线下面积（AUC），并在两组之间进行比较。tcPCO2 组的麻醉师在每次手术后都会收到一份调查问卷。两组患者在手术过程中的 AUC（19,202（7,863-44,944） vs 17,737（9,800-47,566）mmHg - s，P = 0.84）或不同通气策略之间无明显差异。对照组的最大 tcPCO2 水平为 69.2 (62.1-81.2) mm Hg，tcPCO2 组为 71.1 (62.8-80.8) mm Hg，（P = 0.85）。自主呼吸与较低的 tcPCO2 水平有关。麻醉医师对 tcPCO2 监测的总体满意度评分为 8.19 (0.96)。尽管调整了策略，但 tcPCO2 监测的可用性并未影响这些高水平。不过，tcPCO2 监测为二氧化碳负荷和应用通气策略提供了宝贵的见解。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.