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1998, Number 6

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Rev Mex Pediatr 1998; 65 (6)

Sensibilidad y especificidad de las mediciones de CO2 por capnografía vs gasometría en niños con lesión neurológica en estado crítico

Balam CVY, Robles AJF, Pineda SL, Medina RM, Pérez AS, Escudero CJL, Rodríguez ZN, Martínez JÓ, Flores GR

Language: Spanish
References: 20
Page: 245-250
PDF size: 171.72 Kb.


ABSTRACT

Continuos noninvasive monitoring of arterial CO2 tension (PaCO2) estimated by capnography may provide important information of alveolar CO2 changes of respiratory cicles, ventilatory weaning and monitoring of hypocapnia or hypercapnia in critically ill neurological patients, they may cause changes on intracranial pressure and cerebral perfusion pressure.
Objective: To determine the accuracy of End-tidal CO2 monitoring related to arterial CO2 of neurological patients in pediatric intensive care unit (PICU).
Design: Non randomized recording of simultaneous end-tidal and arterial CO2 pairs. A prospective, longitudinal, observational study.
Setting: PICU patients of «Lic. Adolfo Lopez Mateos» regional Hospital, ISSSTE. México, DF.
Patients: With neurological problems: eight mechanical ventilated and eigth intubated spontaneous breathing patients until 16 years old.
Measurements: The correlation coefficient, degree of bias, 95% confidence interval, predictive value, and ability of end-tidal monitor to alert the clinician to instances of hypocapnia or hypercapnia in both groups.
Results: We included 82 end-tidal/larterial pairs from 8 ventilated patients. The correlation coefficient was r2 = 0.60 p ‹ 0.001 and the ETCO2-PaCO2 bias was ± 0.43 mmHg (PaCO2 30.2 ± 6.5 vs ETCO2 29.8 ± 7.6) 95% confidence interval ± 8.07 mmHg. Changes on tidal volume (r2 = 0.72), peep › 2 mmHg (r2 = 0.64) and respiratory rate (r2 = 0.70) had the more important PaCO2-ETCO2 correlations. The capnography identified 25/31 hypocapnic instances (81%), specificity of 94%. The correlation coefficient and bias in spontaneous breathing patients were lower than of ventilated group.
Conclusion: End-tidal CO2 monitoring in PICU neurological patients is a useful, accurate method for recording arterial CO2 changes and similar to gasometry on ventilated patients.


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