Work

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

Year: 2024

Type: article

Abstract: During rigid bronchoscopies and microlaryngeal surgery (MLS) in children, there is currently no reliable method for managing ventilation strategies based on carbon dioxide (CO 2 ) levels. This study aimed to investigate the effects of the clinical implementation of transcutaneous CO 2 (tcPCO 2 ) monitoring during rigid bronchoscopies or MLS. Prospective observational study. Operating theatre of a tertiary pediatric hospital, from January 2019 to March 2021. Children with an age < 18 years, undergoing rigid bronchoscopy or MLS, were eligible for inclusion. Children with tracheostomy and/or skin conditions limiting tcPCO 2 monitoring were excluded. TcPCO 2 monitoring was performed in two groups; blinded before clinical implementation (control group) and visible for ventilation management after clinical implementation (tcPCO 2 group). The total tcPCO 2 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 tcPCO 2 group received a questionnaire after each procedure. 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 tcPCO 2 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 tcPCO 2 group. Spontaneous breathing was associated with lower tcPCO 2 levels. The general satisfaction score of tcPCO 2 monitoring rated by the anesthesiologist was 8.19 (0.96). TcPCO 2 levels reached approximately twice the upper limit of the normal range during rigid bronchoscopy and MLS. Availability of tcPCO 2 monitoring did not affect these high levels, despite adjustments in strategy. However, tcPCO 2 monitoring provides valuable insight in CO 2 load and applied ventilation strategies. • TcPCO 2 levels nearly doubled during airway procedures when compared to baseline. • No difference in CO 2 load was observed after implementation of tcPCO 2 monitoring. • Spontaneous ventilation led to the lowest tcPCO 2 levels. • TcPCO 2 monitoring provides insight in CO 2 load and applied ventilation strategies.

Source: Journal of Clinical Anesthesia

DOI: 10.1016/j.jclinane.2024.111692