The clinical application of transcutaneous carbon dioxide monitoring during rigid bronchoscopy or microlaryngeal surgery in children.

Study Objective: During rigid bronchoscopies and microlaryngeal surgery (MLS) in children, there is currently no reliable method for managing ventilation strategies based on carbon dioxide (CO ₂ ) levels. This study aimed to investigate the effects of the clinical implementation of transcutaneous CO ₂ (tcPCO ₂ ) monitoring during rigid bronchoscopies or MLS.
Design: Prospective observational study.
Setting: Operating theatre of a tertiary pediatric hospital, from January 2019 to March 2021.
Patients: Children with an age < 18 years, undergoing rigid bronchoscopy or MLS, were eligible for inclusion. Children with tracheostomy and/or skin conditions limiting tcPCO ₂ monitoring were excluded.
Interventions: TcPCO ₂ monitoring was performed in two groups; blinded before clinical implementation (control group) and visible for ventilation management after clinical implementation (tcPCO ₂ group).
Measurements: The total tcPCO ₂ load outside of the normal range (35-48 mm Hg) was calculated as the area under the curve (AUC) and compared between the groups. Anesthesiologists in the tcPCO ₂ group received a questionnaire after each procedure.
Main Results: A total of 120 patients were included. No significant differences were found between the two groups in the AUC during the procedure (19,202 (7,863-44,944) vs 17,737 (9,800-47,566) mm Hg · s, P = 0.84) or between different ventilation strategies. The maximal tcPCO ₂ level was 69.2 (62.1-81.2) mm Hg in the control group and 71.1 (62.8-80.8) mm Hg, (P = 0.85) in the tcPCO ₂ group. Spontaneous breathing was associated with lower tcPCO ₂ levels. The general satisfaction score of tcPCO ₂ monitoring rated by the anesthesiologist was 8.19 (0.96).
Conclusions: TcPCO ₂ levels reached approximately twice the upper limit of the normal range during rigid bronchoscopy and MLS. Availability of tcPCO ₂ monitoring did not affect these high levels, despite adjustments in strategy. However, tcPCO ₂ monitoring provides valuable insight in CO ₂ load and applied ventilation strategies.
Competing Interests: Declaration of competing interest The authors have declared no conflict of interest. This study was funded by the Erasmus MC Sophia Foundation (grant number: B1603B).
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)