Measurement of gastric-to-end-tidal carbon dioxide difference in neonates requiring intensive care

摘要

Objective: Gastric-arterial partial CO 2 pressure gap (Pg-aCO 2 gap) measured by gastric tonometry may detect the disturbance of splanchnic perfusion. As in the neonatal age it is very difficult to follow up the circulatory condition with frequent acid-base examinations, we wanted to compare the Pg-aCO 2 gap with an alternative gap of PgCO 2 end-tidal carbon dioxide (Pg-ETCO 2 gap). Methods: A prospective study was performed on ventilated neonates requiring intensive therapy (n 44, weight: 1813 ± 977 g). PETCO 2 and PgCO 2 were measured with a side stream capnograph. We applied a newly developed gastric tonometric probe. Patients were divided into two groups: Group 1 of patients in stable condition (n 35) and Group 2 of patients with severe condition (i.e. Clinical Risk Index for Babies [CRIB] score higher than 10; n 9). For main statistical analysis a mixed model repeated measurements ANOVA, BlandAltman analysis were applied. Results: Pg-ETCO 2 gap was higher than Pg-aCO 2 gap (11.40 ± 7.79 versus 3.63 ± 7.98 mmHg, p 0.01). Both gaps were higher in Group 2 (8.71 ± 10.89 and 18.27 ± 10.49 versus 2.53 ± 6.78 and 9.92 ± 6.22 mmHg, p 0.01 and p 0.05). BlandAltman analysis of the two gaps showed an acceptable correspondence. Conclusions: Pg-ETCO 2 gap may be used as a method for continuous estimation of splanchnic perfusion and a prognostic index also in critically ill neonates. However, the Pg-aCO 2 gap should not be abandoned.