Dr. Enikő Szakmár 1, Dr. Kata Kovács 1, Dr. Ünőke Méder 1, Zsófia Kelló 1, Dr. Miklós Szabó 1, Dr. András Széll 2 Dr. Somogyvári Zsolt 2, Dr. Ágnes Jermendy 1
1, 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
2, Neonatal Emergency & Transport Services of Peter Cerny Foundation, Budapest, Hungary
Introduction: There is increasing evidence that an association exists between hypocapnia and adverse neurodevelopmental outcome in infants with Hypoxic-Ischemic Encephalopathy (HIE) during therapeutic hypothermia (TH). A close monitoring of carbon dioxide (CO2) exchange seems to be highly important. End-tidal CO2 (etCO2) monitoring became recently available as a non-invasive technique to monitor CO2 exchange continuously in mechanically ventilated neonates.
Aim: To assess the accuracy of etCO2 monitoring during neonatal transport by comparing etCO2 data with capillary blood gas measurements (PCO2) in asphyxiated infants undergoing TH.
Method: This is a prospective, single-center, observational trial recruiting term infants with moderate-to-severe HIE receiving mechanical ventilation during TH as per standard of care. All infants have at least two blood gas values recorded during transport. EtCO2 measurement using a main stream capnograph is started before the first blood gas is measured and continued during transport. Bland-Altman (B-A) analysis will be used to assess the agreement between etCO2 and capillary PCO2.
Results: We recruited 16 infants between November 2018 and February 2019. Low Apgar scores and severe metabolic acidosis (pH 7,0 [6,9; 7,1], base deficit 16,3 mmol/L [19,2; 11,1], lactate 14 mmol/L [11; 17]) seen in the first blood gas samples confirm the critical condition of the neonates with a median encephalopathy score of 11 [6; 12]. In total, 37 blood gases were collected between 0,6 and 7,5 hours of life. Normal PCO2 values (>35 and <45 mmHg) were observed only in 16,2 % (6/37) of samples. The rate of hypocapnia (≤35 mmHg) was 29,7% (11/37), whereas hypercapnia (≥ 45 mmHg) was observed in 54,1% (20/37). EtCO2 measurement was feasible in all infants. B-A analysis is still awaited. Target enrollment is planned for 25 patients.
Conclusion: The continuous CO2 monitoring is likely to be an important step to optimize respiratory management and neurodevelopmental outcome in this population.
Doctoral School of Clinical Medicine
Program: Prevention of Chronic Diseases in Childhood
Supervisor: Ágnes Jermendy
E-mail address of the presenter: firstname.lastname@example.org
SUPPORTED BY THE ÚNKP-18-3-III NEW NATIONAL EXCELLENCE PROGRAM OF THE MINISTRY OF HUMAN CAPACITIES