Author Of 1 Presentation
TRANSCUTANEOUS CARBON DIOXIDE MONITORING DURING APNEA TESTING TO DETERMINE NEUROLOGIC DEATH IN CHILDREN: A RETROSPECTIVE CASE SERIES
Abstract
Background
Determination of neurologic death (DND) in children is a clinical diagnosis requiring absence of neurologic function with co-existence of irreversible coma and apnea. Apnea testing (AT) assesses spontaneous respiration when arterial carbon dioxide (PaCO2) increases to ≥ 60mmHg and ≥ 20mmHg above baseline. CO2 measurement during AT for DND in children using transcutaneous carbon dioxide monitoring (TcCO2) is unknown.
Objectives
To assess correlation between paired TcCO2 and PaCO2 values during AT for DND.
Methods
Retrospective case series of children 0-18 years of age undergoing DND between May 2017–December 2018. Location was a 28 bed Pediatric Intensive Care Unit in a 259-bed tertiary care pediatric referral center. Primary outcomes were paired TcCO2 and PaCO2 values obtained during AT. Radiometer TOSCA Monitor (Radiometer America©. Brea, California) was used for all trials.
Results
Eight children (5 male), mean age 2 years (range 0.1-8.1 years) met criteria for DND. 31 paired TcCO2 and PaCO2 values were obtained from 15 DND encounters. TcCO2 and PaCO2 correlated well (r=0.94, p < 0.01). TcCO2 and PaCO2 median difference was 5 mmHg (IQR:3-7) with no correlation to vasoactive inotropic score (r=0.2) or patient temperature (r=0.11). ROC curve of TcCO2 after 3-6 minutes of apnea to discriminate PaCO2 consistent with DND yielded AUC of 0.91 and cut-off value of ≥ 64 mmHg (sensitivity 91.67%, specificity 100%).
Conclusion
TcCO2 demonstrated high accuracy and reliability compared with PaCO2 by blood gas analysis during AT for DND in children. TcCO2 monitoring may reduce redundant arterial gas sampling by identifying appropriate timing to achieve target PaCO2.
Presenter of 1 Presentation
TRANSCUTANEOUS CARBON DIOXIDE MONITORING DURING APNEA TESTING TO DETERMINE NEUROLOGIC DEATH IN CHILDREN: A RETROSPECTIVE CASE SERIES
Abstract
Background
Determination of neurologic death (DND) in children is a clinical diagnosis requiring absence of neurologic function with co-existence of irreversible coma and apnea. Apnea testing (AT) assesses spontaneous respiration when arterial carbon dioxide (PaCO2) increases to ≥ 60mmHg and ≥ 20mmHg above baseline. CO2 measurement during AT for DND in children using transcutaneous carbon dioxide monitoring (TcCO2) is unknown.
Objectives
To assess correlation between paired TcCO2 and PaCO2 values during AT for DND.
Methods
Retrospective case series of children 0-18 years of age undergoing DND between May 2017–December 2018. Location was a 28 bed Pediatric Intensive Care Unit in a 259-bed tertiary care pediatric referral center. Primary outcomes were paired TcCO2 and PaCO2 values obtained during AT. Radiometer TOSCA Monitor (Radiometer America©. Brea, California) was used for all trials.
Results
Eight children (5 male), mean age 2 years (range 0.1-8.1 years) met criteria for DND. 31 paired TcCO2 and PaCO2 values were obtained from 15 DND encounters. TcCO2 and PaCO2 correlated well (r=0.94, p < 0.01). TcCO2 and PaCO2 median difference was 5 mmHg (IQR:3-7) with no correlation to vasoactive inotropic score (r=0.2) or patient temperature (r=0.11). ROC curve of TcCO2 after 3-6 minutes of apnea to discriminate PaCO2 consistent with DND yielded AUC of 0.91 and cut-off value of ≥ 64 mmHg (sensitivity 91.67%, specificity 100%).
Conclusion
TcCO2 demonstrated high accuracy and reliability compared with PaCO2 by blood gas analysis during AT for DND in children. TcCO2 monitoring may reduce redundant arterial gas sampling by identifying appropriate timing to achieve target PaCO2.