Laura L Lambert1, Melissa B Baldwin1, Cruz Velasco Gonzalez2, Gary R Lowe1, J Randy Willis3. 1. Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas. 2. Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas. 3. Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas. willisjr@archildrens.org.
Abstract
BACKGROUND: Transcutaneous monitors are utilized to monitor a patient's respiratory status. Some patients have similar values when comparing transcutaneous carbon dioxide (PtcCO2 ) values with blood gas analysis, whereas others show extreme variability. A retrospective review of data was performed to determine how accurately PtcCO2 correlated with CO2 values obtained by arterial blood gas (ABG) or capillary blood gas. METHODS: To determine whether PtcCO2 values correlated with ABG or capillary blood gas values, subjects' records were retrospectively reviewed. Data collected included the PtcCO2 value at the time of blood gas procurement and the ABG or capillary blood gas PCO2 value. Agreement of pairs of methods (ABG vs PtcCO2 and capillary blood gas vs PtcCO2 ) was assessed with the Bland-Altman approach with limits of agreement estimated with a mixed model to account for serial measurements per subject. RESULTS: A total of 912 pairs of ABG/PtcCO2 values on 54 subjects and 307 pairs of capillary blood gas/PtcCO2 values on 34 subjects were analyzed. The PCO2 range for ABG was 24-106 mm Hg, and PtcCO2 values were 27-133 mm Hg. The PCO2 range for capillary blood gas was 29-108 mm Hg, and PtcCO2 values were 30-103 mm Hg. For ABG/PtcCO2 comparisons, the Pearson correlation coefficient was 0.82, 95% CI was 0.80-0.84, and P was <.001. For capillary blood gas/PtcCO2 comparisons, the Pearson correlation coefficient was 0.77, 95% CI was 0.72-0.81, and P was <.001. For ABG/PtcCO2 , the estimated difference ± SD was -6.79 ± 7.62 mm Hg, and limits of agreement were -22.03 to 8.45. For capillary blood gas/PtcCO2 , the estimated difference ± SD was -1.61 ± 7.64 mm Hg, and limits of agreement were -16.88 to 13.66. The repeatability coefficient was about 30 mm Hg. CONCLUSIONS: Based on these data, capillary blood gas comparisons showed less variation and a slightly lower correlation with PtcCO2 than did ABG comparisons. After accounting for serial measurements per patient, due to the wide limits of agreement and poor repeatability, the utility of relying on PtcCO2 readings for this purpose is questionable.
BACKGROUND: Transcutaneous monitors are utilized to monitor a patient's respiratory status. Some patients have similar values when comparing transcutaneous carbon dioxide (PtcCO2 ) values with blood gas analysis, whereas others show extreme variability. A retrospective review of data was performed to determine how accurately PtcCO2 correlated with CO2 values obtained by arterial blood gas (ABG) or capillary blood gas. METHODS: To determine whether PtcCO2 values correlated with ABG or capillary blood gas values, subjects' records were retrospectively reviewed. Data collected included the PtcCO2 value at the time of blood gas procurement and the ABG or capillary blood gas PCO2 value. Agreement of pairs of methods (ABG vs PtcCO2 and capillary blood gas vs PtcCO2 ) was assessed with the Bland-Altman approach with limits of agreement estimated with a mixed model to account for serial measurements per subject. RESULTS: A total of 912 pairs of ABG/PtcCO2 values on 54 subjects and 307 pairs of capillary blood gas/PtcCO2 values on 34 subjects were analyzed. The PCO2 range for ABG was 24-106 mm Hg, and PtcCO2 values were 27-133 mm Hg. The PCO2 range for capillary blood gas was 29-108 mm Hg, and PtcCO2 values were 30-103 mm Hg. For ABG/PtcCO2 comparisons, the Pearson correlation coefficient was 0.82, 95% CI was 0.80-0.84, and P was <.001. For capillary blood gas/PtcCO2 comparisons, the Pearson correlation coefficient was 0.77, 95% CI was 0.72-0.81, and P was <.001. For ABG/PtcCO2 , the estimated difference ± SD was -6.79 ± 7.62 mm Hg, and limits of agreement were -22.03 to 8.45. For capillary blood gas/PtcCO2 , the estimated difference ± SD was -1.61 ± 7.64 mm Hg, and limits of agreement were -16.88 to 13.66. The repeatability coefficient was about 30 mm Hg. CONCLUSIONS: Based on these data, capillary blood gas comparisons showed less variation and a slightly lower correlation with PtcCO2 than did ABG comparisons. After accounting for serial measurements per patient, due to the wide limits of agreement and poor repeatability, the utility of relying on PtcCO2 readings for this purpose is questionable.
Authors: Ilia Bresesti; Marlies Bruckner; Christian Mattersberger; Nariae Baik-Schneditz; Bernhard Schwaberger; Lukas Mileder; Alexander Avian; Berndt Urlesberger; Gerhard Pichler Journal: Front Pediatr Date: 2020-01-29 Impact factor: 3.418