Monitoring significance of end-respiratory carbon dioxide partial pressure in neonatal respiratory support / 中国小儿急救医学

ABSTRACT

Objective:To compare the neonatal end tidal carbon dioxide pressure(PetCO 2) and its correlation with arterial carbon dioxide pressure(PaCO 2) monitored by non-invasive mask, accessory flow nasal catheter and invasive mechanical ventilation. Methods:From October 2017 to January 2020, 53 cases of newborn who were needed respiratory support treatment in our hospital were selected.PetCO 2was detected at admission, respiratory support and after weaning, including nasal catheter, non wound mask and invasive ventilation, and at the same time matching analysis of the corresponding with PaCO 2artery blood gas analysis. Results:(1) PetCO 2monitored by mask was lower than PaCO 2[(40.41 ± 10.21) mmHg vs.(42.85 ± 10.32) mmHg(1 mmHg=0.133 kPa), t=11.88, P<0.01], and there was a significant positive correlation between PetCO 2and PaCO 2( r=0.97, P<0.01); the mean bias of PetCO 2monitored by mask was(1.20 ± 2.31) mmHg, only 4.5%(5/110) was outside the 95% confidence interval.(2) PetCO 2monitored by nasal catheter was also lower than the mean PaCO 2[(40.93 ± 10.55) mmHg vs.(42.01 ± 10.50) mmHg, t=4.12, P<0.01], showing a significant positive correlation( r=0.96, P<0.01); the mean bias of PetCO 2monitored by nasal catheter was(2.44 ± 2.56) mmHg, and only 4.6%(7/150) was beyond the 95% confidence interval.(3) PetCO 2of neonates with endotracheal intubation and mechanical ventilation was also lower than PaCO 2[(43.33±10.26) mmHg vs. (49.37±11.34) mmHg, t=13.83, P<0.01], and there was also a significant positive correlation between the two groups, which was lower than that of neonates with non-invasive ventilation( r=0.94, P<0.01). The mean PetCO 2bias for neonates with invasive positive pressure ventilation was(0.90±0.82) mmHg, and only 3.9%(2/51) were outside the 95% confidence interval.(4) According to gestational age, the PetCO 2of early and late preterm infants was(37.25±11.32) mmHg and(39.58±10.37) mmHg, respectively, which were lower than that of full-term infants[(42.69±10.66) mmHg], and there was a positive correlation between PetCO 2and PaCO 2in all three groups.The correlation between PetCO 2and PaCO 2in early preterm infants was the lowest among the three groups( r=0.89, P<0.01). Conclusion:The monitoring of PetCO 2through nasal catheter, mask and invasive ventilation has a good correlation and consistency with the level of PaCO 2in neonates, which can accurately reflect the level of PaCO 2in neonates.The correlation between PetCO 2and PaCO 2in neonates with non-invasive ventilation is better than that in neonates with invasive ventilation.The correlation between PetCO 2and PaCO 2in late preterm infants and term infants is better than that in early preterm infants.