PhD Scientific Days 2019

Budapest, April 25–26, 2019

Monitoring Carbon- Dioxide Exchange During Hypothermia for Hypoxic-Ischemic Encephalopathy

Szakmár, Enikő

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

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Text of the abstract

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.

Data of the presenter

Doctoral School of Clinical Medicine
Program: Prevention of Chronic Diseases in Childhood
Supervisor: Ágnes Jermendy
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