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Setar L, Lee JG, Sanchez-Pinto LN, Coates BM. Accuracy and Interpretation of Transcutaneous Carbon Dioxide Monitoring in Critically Ill Children. Pediatr Crit Care Med 2024; 25:e372-e379. [PMID: 39288436 PMCID: PMC11368163 DOI: 10.1097/pcc.0000000000003564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
OBJECTIVES Transcutaneous carbon dioxide (Tc co2 ) monitoring can noninvasively assess ventilation by estimating carbon dioxide ( CO2 ) levels in the blood. We aimed to evaluate the accuracy of Tc co2 monitoring in critically ill children by comparing it to the partial pressure of arterial carbon dioxide (Pa co2 ). In addition, we sought to determine the variation between Tc co2 and Pa co2 acceptable to clinicians to modify patient care and to determine which patient-level factors may affect the accuracy of Tc co2 measurements. DESIGN Retrospective observational cohort study. SETTING Single, quaternary care PICU from July 1, 2012, to August 1, 2020. PATIENTS Included participants were admitted to the PICU and received noninvasive ventilation support (i.e., continuous or bilevel positive airway pressure), conventional mechanical ventilation, or high-frequency oscillatory or percussive ventilation with Tc co2 measurements obtained within 15 minutes of Pa co2 measurement. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Three thousand four hundred seven paired arterial blood gas and Tc co2 measurements were obtained from 264 patients. Bland-Altman analysis revealed a bias of -4.4 mm Hg (95% CI, -27 to 18.3 mm Hg) for Tc co2 levels against Pa co2 levels on the first measurement pair for each patient, which fell within the acceptable range of ±5 mm Hg stated by surveyed clinicians, albeit with wide limits of agreement. The sensitivity and specificity of Tc co2 to diagnose hypercarbia were 93% and 71%, respectively. Vasoactive-Infusion Score (VIS), age, and self-identified Black/African American race confounded the relationship between Tc co2 with Pa co2 but percent fluid overload, weight-for-age, probe location, and severity of illness were not significantly associated with Tc co2 accuracy. CONCLUSIONS Tc co2 monitoring may be a useful adjunct to monitor ventilation in children with respiratory failure, but providers must be aware of the limitations to its accuracy.
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Affiliation(s)
- Leah Setar
- Ann and Robert H. Lurie Children’s Hospital, Chicago, IL
- Division of Pediatrics, Northwestern McGaw Medical Center, Chicago, IL
| | - Jessica G. Lee
- Ann and Robert H. Lurie Children’s Hospital, Chicago, IL
- Division of Pediatrics, Northwestern McGaw Medical Center, Chicago, IL
| | - L. Nelson Sanchez-Pinto
- Ann and Robert H. Lurie Children’s Hospital, Chicago, IL
- Division of Pediatrics, Northwestern McGaw Medical Center, Chicago, IL
| | - Bria M. Coates
- Ann and Robert H. Lurie Children’s Hospital, Chicago, IL
- Division of Pediatrics, Northwestern McGaw Medical Center, Chicago, IL
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Mondardini MC, Pezzato S, Meneghini L, Agostiniani R, De Cassai A, D'Errico I, Minardi C, Sagredini R, Sbaraglia F, Testoni C, Toni F, Vason M, Amigoni A. Procedural sedation and analgesia in pediatric diagnostic and interventional radiology: An expert DELPHI consensus document developed by the ITALIAN scientific society of anesthesia, analgesia, resuscitation and intensive care (SIAARTI). Paediatr Anaesth 2024. [PMID: 38808388 DOI: 10.1111/pan.14936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Children undergoing diagnostic and interventional radiology procedures often require sedation to achieve immobility and analgesia if the procedure is painful. In the past decades, leading scientific organizations have developed evidence-based guidelines for procedural sedation and analgesia in children outside of the operating room. Their recommendations are being applied to procedural sedation in radiology. However, some questions remain open regarding specific aspects contextualized to the radiology setting, such as elective prone sedation, the urgency of the procedure, when venous access or airway protection is required, and others. AIMS To address the unresolved issues of procedural sedation and analgesia in pediatric diagnostic and interventional radiology. METHODS An expert panel of pediatricians, pediatric anesthesiologists, intensivists, and neuroradiologists selected topics representative of current controversies and formulated research questions. Statements were developed by reviewing the literature for new evidence, comparing expertise and experience, and expressing opinions. Panelists' agreement with the statements was collected anonymously using the DELPHI method. RESULTS Twelve evidence-based or expert opinion incorporate are presented, considering risks, benefits, and applicability. CONCLUSIONS This consensus document, developed by a multidisciplinary panel of experts involved in the field, provides statements to improve the quality of decision-making practice in procedural sedation and analgesia in pediatric radiology.
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Affiliation(s)
| | - Stefano Pezzato
- Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Luisa Meneghini
- Department of Pediatric Surgery, University Hospital of Padova, Padova, Italy
| | | | - Alessandro De Cassai
- Department of Medicine, Anaesthesia and Intensive Care Unit, University Hospital of Padova, Padova, Italy
| | - Ignazio D'Errico
- Department of Neuroradiology, University Hospital of Padova, Padova, Italy
| | - Carmelo Minardi
- Department of Anesthesiology, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Raffaella Sagredini
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Fabio Sbaraglia
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Gemelli IRCCS, Sacro Cuore Catholic University, Rome, Italy
| | - Caterina Testoni
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesco Toni
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Milo Vason
- Department of Emergency, Anaesthesiology and Intensive Care Unit, Arcispedale Sant'Anna, University of Ferrara, Cona, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, University Hospital of Padova, Padova, Italy
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Shahid S, Geetha M, Sadasivuni KK, Remani D, Muthusamy S, Muthalif AGA, Al-maadeed S. Highly sensitive and selective colorimetric sensing of CO 2 for biomedical applications. 3 Biotech 2022; 12:334. [PMID: 36330379 PMCID: PMC9622963 DOI: 10.1007/s13205-022-03396-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/12/2022] [Indexed: 12/02/2022] Open
Abstract
The concentration of carbon dioxide (CO2) in unhealthy people differs greatly from healthy people. High-precision CO2 detection with a quick response time is essential for many biomedical applications. A major focus of this research is on the detection of CO2, one of the most important health biomarkers. We investigated a low-cost, flexible, and reliable strategy by using dyes for colorimetric CO2 sensing in this study. The impacts of temperature, pH, reaction time, reusability, concentration, and dye selectivity were studied thoroughly. This study described real-time CO2 analysis. Using this multi-dye method, we got an average detection limit of 1.98 ppm for CO2, in the range of 50-120 ppm. A portable colorimetric instrument with a smartphone-assisted unit was constructed to determine the relative red/green/blue values for real-time and practical applications within 15 s of interaction and the readings are very similar to those of an optical fiber probe. Environmental and biological chemistry applications are likely to benefit greatly from this unique approach.
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Affiliation(s)
- Shahina Shahid
- Center for Advanced Materials, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Mithra Geetha
- Center for Advanced Materials, Qatar University, P.O. Box 2713, Doha, Qatar
| | | | - Divya Remani
- Center for Advanced Materials, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Suresh Muthusamy
- Department of Electronics and Communication Engineering, Kongu Engineering College, Erode, Tamil Nadu India
| | - Asan G. A. Muthalif
- Department of Mechanical and Industrial Engineering, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Somaya Al-maadeed
- Department of Computer Science and Engineering, Qatar University, P.O. Box 2713, Doha, Qatar
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4
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Evans B, Dore S, Couser D. Review of pediatric hypercarbia and intraoperative management. Curr Opin Anaesthesiol 2022; 35:248-254. [PMID: 35191401 DOI: 10.1097/aco.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Hypercarbia in pediatric patients is an important component of intraoperative management. Despite marked advances in medicine and technology, it is uncertain what the physiological CO2 range in neonates, infants and small children. This data is extrapolated from the adult population. We are going to review advantages and disadvantages of CO2 measurement techniques, causes and systemic effects of hypercarbia. We are going to discuss how to approach management of intraoperative hypercarbia. RECENT FINDINGS Although physiological range in this patient population may not be fully understood, it is known that any rapid change from a child's baseline increases risks of complications. Any derangements in CO2 are further compromised by hypoxia, hypotension, hypothermia, anemia, all of which may occur in a dynamic operating room environment. SUMMARY Pediatric anesthesiologists and their teams must remain vigilant and anticipate these developments. Care must be taken to avoid any rapid changes in these vulnerable patients to minimize risks of adverse outcomes.
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Affiliation(s)
- Beata Evans
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Seamas Dore
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
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Spaeth J, Schumann S, Humphreys S. Understanding pediatric ventilation in the operative setting. Part II: Setting perioperative ventilation. Paediatr Anaesth 2022; 32:247-254. [PMID: 34877746 DOI: 10.1111/pan.14366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022]
Abstract
Approaches toward lung-protective ventilation have increasingly been investigated in recent years. Despite evidence being found in adults undergoing surgery, data in younger children are still scarce and controversial. From a physiological perspective, however, the continuously changing characteristics of the respiratory system from birth through adolescence require an approach based on the analysis of each individual patient. The modern anesthesia workstation provides such information, with the technical strengths and weaknesses being discussed in a review preceding the present work (see Part I). The present summary aims to provide ideas on how to translate the information displayed on the anesthesia workstation to patient-oriented clinical ventilation settings.
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Affiliation(s)
- Johannes Spaeth
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Schumann
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susan Humphreys
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia.,Department of Anaesthesia, Queensland, Children's Hospital, South Brisbane, Qld, Australia
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Spaeth J, Schumann S, Humphreys S. Understanding pediatric ventilation in the operative setting. Part I: Physical principles of monitoring in the modern anesthesia workstation. Paediatr Anaesth 2022; 32:237-246. [PMID: 34902201 DOI: 10.1111/pan.14378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/27/2022]
Abstract
The modern anesthesia workstation provides a wealth of information some of which is of particular interest when it comes to optimizing ventilation settings. This knowledge gains even more importance in the therapy of pediatric patients. In the absence of evidence-based recommendations on optimal ventilation settings in pediatric patients, the evaluation of individual factors becomes crucial and challenging at the same time. Even when equipped with the latest sensor technology, the user will always have to be in charge of interpreting the provided monitoring variables. The purpose of this review is to outline the clinical impact, technological background, and reliability of the most relevant information measured and calculated by a modern anesthesia workstation. It aims at translating the technical knowledge into a more competent and vigilant application in the clinical setting.
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Affiliation(s)
- Johannes Spaeth
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Schumann
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susan Humphreys
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Department of Anaesthesia, Queensland Children's Hospital, South Brisbane, Queensland, Australia
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