Factors affecting the arterial to end-tidal carbon dioxide gradient in ventilated neonates. 2022

Emma Williams, and Nadja Bednarczuk, and Theodore Dassios, and Anne Greenough
Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom.

Objective. To determine factors which influenced the relationship between blood carbon dioxide (pCO2) and end-tidal carbon dioxide (EtCO2) values in ventilated, newborn infants. Furthermore, to assess whether pCO2levels could be predicted from continuous EtCO2monitoring.Approach. An observational study of routinely monitored newborn infants requiring mechanical ventilation in the first 28 d after birth was undertaken. Infants received standard clinical care. Daily pCO2and EtCO2levels were recorded and the difference (gradient: ∆P-EtCO2) between the pairs were calculated. Ventilatory settings corresponding to the time of each blood gas assessment were noted. End-tidal capnography monitoring was performed using the Microstream sidestream Filterline H set capnograph.Main results. A total of 4697 blood gas results from one hundred and fifty infants were analysed. The infants had a median gestational age of 33.3 (range 22.3-42.0) weeks and birth weight of 1880 (395-5520) grams. Overall, there was moderate correlation between pCO2and EtCO2levels (r= 0.65,p< 0.001). The ∆P-EtCO2for infants born less than 32 weeks of gestation was significantly higher (1.4 kPa) compared to infants born at greater than 32 weeks of gestation (0.8 kPa) (p< 0.001). In infants born at less than 32 completed weeks of gestation, pCO2levels were independently associated with EtCO2, day after birth, birthweight and fraction of inspired oxygen (FiO2) (modelr2 = 0.52,p< 0.001).Significance. The results of end-tidal capnography monitoring have the potential to predict blood carbon dioxide values within the neonatal population.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D010100 Oxygen An element with atomic symbol O, atomic number 8, and atomic weight [15.99903; 15.99977]. It is the most abundant element on earth and essential for respiration. Dioxygen,Oxygen-16,Oxygen 16
D001724 Birth Weight The mass or quantity of heaviness of an individual at BIRTH. It is expressed by units of pounds or kilograms. Birthweight,Birth Weights,Birthweights,Weight, Birth,Weights, Birth
D002245 Carbon Dioxide A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. Carbonic Anhydride,Anhydride, Carbonic,Dioxide, Carbon
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001158 Arteries The vessels carrying blood away from the heart. Artery
D019296 Capnography Continuous recording of the carbon dioxide content of expired air. Capnographies

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