Transcutaneous Carbon Dioxide Monitoring During Weaning From Mechanical Ventilation in Children: The WeanCO₂ Study.

IF 2.7 3区医学 Q1 PEDIATRICS

Pediatric Pulmonology Pub Date : 2025-05-01 DOI:10.1002/ppul.71115

Meryl Vedrenne-Cloquet, Charlotte Collignon, Noémie De Cacqueray, Mathilde Grapin, Mehdi Oualha, Sylvain Renolleau, Lucie Griffon, Sonia Khirani, Brigitte Fauroux

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引用次数: 0

Abstract

Introduction: Spontaneous breathing trial (SBT) is recommended during weaning from mechanical ventilation (MV), but objective and easy tools lack to identify pediatric weaning failure. We aimed to assess whether changes in estimated arterial CO₂ (PaCO₂) derived from transcutaneous measurements (P_TCCO₂) were associated with pediatric weaning failure.

Methods: Children (age 72 h -18 years) with MV > 12 h were continuously monitored using a transcutaneous sensor to estimate PaCO₂ from skin CO₂ tension (P_TCCO₂). Values were recorded during SBT (30 min on positive end-expiratory pressure (PEEP) +5 cmH₂O, with pressure support of +5 cmH₂O for endotracheal tubes with internal diameter ≤ 3.5 mm), then up to 6 h after extubation. Mean P_TCCO₂ and P_TCCO₂ changes during SBT, and after extubation, were retrospectively collected to evaluate their association with SBT failure and extubation failure (reintubation within 48 h).

Results: Eighty children (median [IQR] age 1.1 [0.3; 8.7] years) were included, with 89 SBT (14 failures, 75 successes). Sixty-four patients were extubated following their first SBT, with 10 (16%) extubation failures. P_TCCO₂ changes were not associated with SBT and extubation failures. Patients who failed extubation had a higher mean P_TCCO₂ value after extubation as compared to those who were successfully extubated (mean P_TCCO₂ of 51.8 [46.2; 55.4] vs. 42.3 [37.5; 47.2] mmHg, p = 0.02). The difference between the maximal P_TCCO₂ value within the 2 h following extubation and the value at extubation were higher in patients who failed extubation (ΔP_TCCO₂ of 20 [9.1; 26] vs. 6.8 [2.9; 9.7] mmHg, p < 10^-2).

Conclusion: Early post-extubation increase in estimated PaCO₂ was associated with extubation failure, whereas P_TCCO₂ changes during SBT were not.

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儿童机械通气脱机期间经皮二氧化碳监测：脱机二氧化碳研究。

简介：建议在机械通气（MV）脱机时进行自主呼吸试验（SBT），但缺乏客观和简单的工具来识别儿童脱机失败。我们的目的是评估经皮测量（PTCCO₂）得出的估计动脉CO₂（PaCO₂）的变化是否与儿童断奶失败有关。方法：使用经皮传感器连续监测年龄为72 h -18岁的儿童（MV bb0 12 h），通过皮肤CO₂张力（PTCCO₂）估计PaCO₂。记录SBT期间（呼气末正压(PEEP) +5 cmH2O 30 min，内径≤3.5 mm气管插管+5 cmH2O压力支持）至拔管后6 h的数值。回顾性收集SBT期间和拔管后的平均PTCCO2和PTCCO2变化，以评估其与SBT失败和拔管失败（48小时内重新拔管）的关系。结果：80例儿童(中位[IQR]年龄1.1 [0.3；8.7]年)，89例SBT（14例失败，75例成功）。64例患者在首次SBT后拔管，其中10例（16%）拔管失败。PTCCO2变化与SBT和拔管失败无关。拔管失败的患者拔管后PTCCO2平均值高于拔管成功的患者(平均PTCCO2为51.8 [46.2；55.4 vs. 42.3 [37.5；47.2] mmHg, p = 0.02)。拔管失败患者拔管后2 h内最大PTCCO2值与拔管时最大PTCCO2值的差异较大(ΔPTCCO2 = 20 [9.1；[26] vs. 6.8 [2.9；9.7] mmHg, p -2)。结论：拔管后早期PaCO₂升高与拔管失败有关，而SBT期间PTCCO₂变化与拔管失败无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Pulmonology 医学-呼吸系统

CiteScore

6.00

自引率

12.90%

发文量

468

审稿时长

3-8 weeks

期刊介绍： Pediatric Pulmonology (PPUL) is the foremost global journal studying the respiratory system in disease and in health as it develops from intrauterine life though adolescence to adulthood. Combining explicit and informative analysis of clinical as well as basic scientific research, PPUL provides a look at the many facets of respiratory system disorders in infants and children, ranging from pathological anatomy, developmental issues, and pathophysiology to infectious disease, asthma, cystic fibrosis, and airborne toxins. Focused attention is given to the reporting of diagnostic and therapeutic methods for neonates, preschool children, and adolescents, the enduring effects of childhood respiratory diseases, and newly described infectious diseases. PPUL concentrates on subject matters of crucial interest to specialists preparing for the Pediatric Subspecialty Examinations in the United States and other countries. With its attentive coverage and extensive clinical data, this journal is a principle source for pediatricians in practice and in training and a must have for all pediatric pulmonologists.