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

Vasthy Yadina Balam Canché; Jorge F Robles Alarcón; Leticia Pineda Suasto; Marino Medina Ramírez; Sergio Pérez Araúz; José Luis Escudero Castro; Natalia Rodríguez Zenteno; Óscar Martínez Jiménez; Raúl Flores Galindo

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

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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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