Improving the Clinical Interpretation of Transcutaneous Carbon Dioxide and Oxygen Measurements in the Neonatal Intensive Care Unit

Improving the Clinical Interpretation of Transcutaneous Carbon Dioxide and Oxygen Measurements in the Neonatal Intensive Care Unit

van Essen, Tanja (Erasmus MC)
Gangaram-Panday, Norani H. (Erasmus MC)
van Weteringen, Willem (Erasmus MC)
Goos, T.G. (TU Delft Medical Instruments & Bio-Inspired Technology; Erasmus MC)
Reiss, Irwin K.M. (Erasmus MC)
de Jonge, Rogier C.J. (Erasmus MC)

2023

Introduction: Transcutaneous blood gas monitoring allows for continuous non-invasive evaluation of carbon dioxide and oxygen levels. Its use is limited as its accuracy is dependent on several factors. We aimed to identify the most influential factors to increase usability and aid in the interpretation of transcutaneous blood gas monitoring. Methods: In this retrospective cohort study, transcutaneous blood gas measurements were paired to arterial blood gas withdrawals in neonates admitted to the neonatal intensive care unit. The effects of patient-related, microcirculatory, macrocirculatory, respiratory, and sensor-related factors on the difference between transcutaneously and arterially measured carbon dioxide and oxygen values (ΔPCO2 and ΔPO2) were evaluated using marginal models. Results: A total of 1,578 measurement pairs from 204 infants with a median [interquartile range] gestational age of 273/7 [261/7-313/7] weeks were included. ΔPCO2 was significantly associated with the postnatal age, arterial systolic blood pressure, body temperature, arterial partial pressure of oxygen (PaO2), and sensor temperature. ΔPO2 was, with the exception of PaO2, additionally associated with gestational age, birth weight Z-score, heating power, arterial partial pressure of carbon dioxide, and interactions between sepsis and body temperature and sepsis and the fraction of inspired oxygen. Conclusion: The reliability of transcutaneous blood gas measurements is affected by several clinical factors. Caution is recommended when interpreting transcutaneous blood gas values with an increasing postnatal age due to skin maturation, lower arterial systolic blood pressures, and for transcutaneously measured oxygen values in the case of critical illness.

Blood gas
Microcirculation
Neonate
Transcutaneous

http://resolver.tudelft.nl/uuid:6e81e8c2-abaa-4a7f-ac17-3129d6f9c29c

https://doi.org/10.1159/000529187

1661-7800

Neonatology, 120 (3), 308-316

Institutional Repository

journal article

© 2023 Tanja van Essen, Norani H. Gangaram-Panday, Willem van Weteringen, T.G. Goos, Irwin K.M. Reiss, Rogier C.J. de Jonge