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Pulse oximeter-enhanced accuracy of capnometry in children with cyanotic heart disease

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Objectives. To evaluate the relationship between the arterial end-tidal partial pressure of carbon dioxide (PCO2) difference (ΔpCO2) and the degree of desaturation in children with cyanotic heart disease (CHD) and to come to a more reliable estimation of the arterial carbon dioxide partial pressure (PaCO2) from the end-tidal carbon dioxide partial pressure (PET-CO2).

Design and setting. In part retrospective, in part prospective observational study at a university children's hospital.

Subjects and interventions. We retrospectively assessed the relationship between the arterial oxygen saturation as measured by means of pulse oximetry (SpO2) and the arterial to end-tidal PCO2 differences (ΔPCO2) from the records of medical or surgical interventions in 43 patients with CHD. We derived a PaCO2-PET-CO2 correction formula that was prospectively validated in 34 patients with CHD.

Measurements and results. In the retrospective part we found a significant correlation between SpO2 and ΔPCO2 (r 2=0.84, p<0.001). The regression equation (corrected PET-CO2=raw PET-CO2–0.36×SpO2+39) was used in the prospective part to calculate the corrected PET-CO2. The r 2s for the correlations between PaCO2 and uncorrected and corrected PET-CO2 were 0.17 (p<0.05) and 0.94 (p<0.001), respectively. The uncorrected PET-CO2 bias was 13.0 mmHg, the bias ± 2SDs was –0.1 and 26.2 mmHg. The corrected PET-CO2 bias was –0.6 mmHg, the bias ± 2SD's was –4.0 and 2.9 mmHg.

Conclusions. Correcting the PET-CO2 for the degree of hypoxia using the SpO2 in artificially ventilated infants and children with CHD results in a clinically applicable estimation of the PaCO2. As both SpO2 and PET-CO2 can be monitored continuously and non-invasively, this could facilitate artificial ventilation management in children with CHD.

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De Vries, J.W., Plötz, F.B. & Van Vught, J.A. Pulse oximeter-enhanced accuracy of capnometry in children with cyanotic heart disease. Intensive Care Med 28, 1336–1339 (2002). https://doi.org/10.1007/s00134-002-1409-0

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  • Pediatric anesthesia Respiratory monitoring Capnometry Cyanotic heart disease