Comparison of arterial CO2 estimation by end-tidal and transcutaneous CO2 measurements in intubated children and variability with subject related factors.

Transcutaneous PCO2 (PTCCO2) and end-tidal PCO2 (PETCO2) measurement methods serve as alternatives to arterial PCO2 (PaCO2), providing continuous non-invasive monitoring. The objective of this study was to evaluate the PTCCO2 and PETCO2 methods with actual PaCO2 levels, and to assess the variability of measurements in relation to subject-related factors, such as skin and subcutaneous adipose tissue thickness and presence of pulmonary diseases. PTCCO2, PETCO2 and PaCO2 were measured at the same time in intubated pediatric subjects. Subjects' demographic characteristics, clinical features, laboratory parameters, skin and subcutaneous adipose tissue thickness were identified. The study was carried out on 102 subjects with a total of 1118 values for each method. In patients with non-pulmonary disease, the mean difference between PTCCO2 and PaCO2 was - 0.29 mmHg (± 6.05), while it was 0.44 mmHg (± 6.83) bias between PETCO2 and PaCO2. In those with pulmonary diseases, the mean difference between PTCCO2 and PaCO2 was - 1.27 mmHg (± 8.32), while it was - 4.65 mmHg (± 9.01) between PETCO2 and PaCO2. Multiple linear regression demonstrated that increased subcutaneous adipose tissue thickness, core body temperature and inotropic index were related with higher PTCCO2 values relative to the actual PCO2 values. Other factors, such as skin tissue thickness, presence of pulmonary disease, measurement location and measurement times were non-significant. The PTCCO2 method has higher reliability than the PETCO2 method, and PTCCO2 measurements are not influenced by most subject-related factors; however, core body temperature, inotropic index and subcutaneous adipose tissue thickness can lead to significant differences in PCO2 measurement.

Comparing the novel microstream and the traditional mainstream method of end-tidal CO2 monitoring with respect to PaCO2 as gold standard in intubated critically ill children.

The objective of this study was to evaluate a novel microstream method by comparison with PaCO2 and the more standard mainstream capnometer in intubated pediatric patients. We hypothesized that the novel microstream method would superior compared to the traditional mainstream method in predicting PaCO2. This was a prospective single-center comparative study. The study was carried out on 174 subjects with a total of 1338 values for each method. Data were collected prospectively from mainstream and microstream capnometer simultaneously and compared with PaCO2 results. Although both mainstream PetCO2 (mainPetCO2) and microstream PetCO2 (microPetCO2) were moderately correlated (r = 0.63 and r = 0.68, respectively) with PaCO2 values, mainPetCO2 was in better agreement with PaCO2 in all subjects (bias ± precision values of 3.8 ± 8.9 and 7.3 ± 8.2 mmHg, respectively). In those with severe pulmonary disease, the mainPetCO2 and microPetCO2 methods were highly correlated with PaCO2 (r = 0.80 and r = 0.81, respectively); however, the biases of both methods increased (14.8 ± 9.1 mmHg and 16.2 ± 9.0 mmHg, respectively). In cases with increased physiologic dead space ventilation, the agreement levels of mainPetCO2 and microPetCO2 methods became distorted (bias ± precision values of 20.9 ± 11.2 and 25.0 ± 11.8 mm Hg, respectively) even though mainPetCO2 and microPetCO2 were highly correlated (r = 0.78 and r = 0.78, respectively). It was found that the novel microstream capnometer method for PetCO2 measurements provided no superiority to the traditional mainstream method. Both capnometer methods may be useful in predicting the trend of PaCO2 due to significant correlations with the gold standard measurement in cases with severe pulmonary disease or increased physiological dead space -despite reduced accuracy.

Late-onset pulmonary edema and disseminated intravascular coagulation due to latex anaphylaxis.

BACKGROUND: Anaphylaxis after the administration of tissue expanders has been reported. Late onset hypotension, thrombocytopenia, disseminated intravascular coagulation (DIC) and pulmonary edema due to the tissue expanders have not been reported. METHODS: In this case report, late onset hypotension, thrombocytopenia, disseminated intravascular coagulation and pulmonary edema due to the administration of tissue expanders were described. RESULTS: The authors report a 16-year-old girl with burn scar deformities scheduled for reconstruction of the scar contractures with insertion of tissue expanders in which the administration of latex tissue expanders was associated with late onset hypotension, thrombocytopenia, disseminated intravascular coagulation and pulmonary edema. Skin tests performed for latex demonstrated strong positive weal and flare reactions. CONCLUSION: Late onset anaphylactic reactions due to latex tissue expanders, an unusual unpredictable adverse reaction, must be kept in mind. Early recognition and proper emergent treatment are essential to reversing this complication.