Objective. Arterial oxygen saturation (SaO2) and arterial carbon dioxide partial pressure (PaCO2) are 2 of the most important respiratory parameters in the treatment of critically ill neonates. Noninvasive monitoring ...Objective. Arterial oxygen saturation (SaO2) and arterial carbon dioxide partial pressure (PaCO2) are 2 of the most important respiratory parameters in the treatment of critically ill neonates. Noninvasive monitoring of these parameters is desirable for continuous estimating of the respiratory status and reducing blood loss because of repeated blood gas analyses. Transcutaneous measurement of PCO2 (PtcCO2) represents a simple and noninvasive technique for continuous monitoring of ventilation. However, sensor preparation, positioning, taping, and repeated changes of the sensor location make the handling difficult and complicate its use in the neonatal care unit. Recently, a new sensor for combined assessment o f pulse oximetry oxygen saturation (SpO2) and PtcCO2 has been introduced (TOSCA Monitor; Linde Medical Sensors, Basel, Switzerland). The monitor combines pulse oximetry and PtcCO2 measurement in a single ear sensor, which works at 42°C to enhance blood flow in capillaries below the sensor. Methods. In a prospective, open, nonrandomized study of 60 ill neonates, the new ear sensor for combined assessment of SpO2 and PtcCO2 at 42°C was tested. The sensor was adapted to the ear of a neonate with a Varihesive layer (Conva Tec; Princeton, NJ). Data obtained from the ear sensor were compared with SpO2 Finger/Heel, SaO2, and PaCO2 obtained from arterial blood gas in 30 patients and with a capillary blood gas in an additional 30 patients using Bland Altman bias analysis. Data are presented as median (range). Results. The postconceptional age of the patients was 38.3 weeks (range: 28 5/7-40 5/7) in the arterial group and 37.9 weeks (range: 29 6/7-41 0/7) in the capillary group. Age of the newborns studied was 3.5 days (range: 1-28) in the arterial blood sample group (n = 30) and 6 days (range: 2-28) in the capillary blood sample group (n = 30). Patient weight was 3.02 kg (range: 1.5-4.5) in the arterial group and 2.76 kg (range: 1.0-3.71) in the other group. Three patients had weights of < 1500 g. Twenty-one of 60 patients were conventionally ventilated, 4 patients received high-freque- ncy oscillation, and 35 were not ventilated. Mean difference (bias) and precision (2 SD of the mean difference) between PtcCO2TOSCA and PaCO2 were -0.44 kPa (-3.21 mm Hg) and 0.82 kPa (6.02 mm Hg) and between PtcCO2TOSCA and PcapCO2 were -0.09 kPa (-0.67mm Hg) and 1.11 kPa (8.07 mm Hg), respectively. SpO2 assessment by the TOSCA revealed slightly higher values compared with SaO2 (bias: -0.48%), whereas SpO2Finger/Heel values were slightly lower than SaO2 (bias: 0.52%). Conclusion. The TOSCA monitor with the ear sensor adapted to ears of neonates allows reliable estimation of SaO2 and PaCO2. A potential benefit is the reduction in motion artifacts because of less head movement in new-borns and that onl y a single cable leads form the patient to the monitor. In addition, the sensor is not removed for chest radiograph or for nursing the infant on his or her parent’s lap. Long-term studies in a large population with continuous measurements are required to confirm these preliminary findings and to elucidate the benefits in detection of respiratory deterioration and the potential side effects of this sensor.展开更多
目的探索气管内脉搏氧饱和度监测的信号来源,并观察影响信号质量的相关因素。方法将杂种犬麻醉后经口腔插入前端贴附一次性儿童氧饱和度探头的气管导管。开胸直视下,让气管内氧饱和度探头发射的红光对准单侧气管旁大动脉,暂时阻断气管...目的探索气管内脉搏氧饱和度监测的信号来源,并观察影响信号质量的相关因素。方法将杂种犬麻醉后经口腔插入前端贴附一次性儿童氧饱和度探头的气管导管。开胸直视下,让气管内氧饱和度探头发射的红光对准单侧气管旁大动脉,暂时阻断气管旁大动脉,观察阻断前后经气管脉搏血氧饱和度(SptO2)的脉搏光容积描记(PPG)波形和读数变化。用照片采集SptO2的最佳信号,调节气管导管套囊内压力,观察不同套囊压力下机械通气与否对信号波形和读数的影响,并与来自犬尾的脉搏氧饱和度(SpO2)做比较。结果当气管内氧饱和度探头所对准的气管旁大动脉被阻断时,SptO2的信号消失。机械通气和套囊压力均可使SptO2信号产生变化(P<0.001)。套囊压力为0、10 cm H2O时SptO2信号与套囊压力为20～60 cm H2O时相比差异有统计学意义(P<0.001),机械通气下的SptO2波形与无机械通气时不同(P<0.01),且与SpO2的差异有统计学意义(P<0.01)。结论SptO2的信号主要来自于气管周围的大动脉而非气管壁本身,气管套囊压力与机械通气对SptO2信号的读数均有影响,套囊压力在20～60 cm H2O时比10 cm H2O的SptO2信号更好,机械通气主要影响信号的波形。展开更多
文摘Objective. Arterial oxygen saturation (SaO2) and arterial carbon dioxide partial pressure (PaCO2) are 2 of the most important respiratory parameters in the treatment of critically ill neonates. Noninvasive monitoring of these parameters is desirable for continuous estimating of the respiratory status and reducing blood loss because of repeated blood gas analyses. Transcutaneous measurement of PCO2 (PtcCO2) represents a simple and noninvasive technique for continuous monitoring of ventilation. However, sensor preparation, positioning, taping, and repeated changes of the sensor location make the handling difficult and complicate its use in the neonatal care unit. Recently, a new sensor for combined assessment o f pulse oximetry oxygen saturation (SpO2) and PtcCO2 has been introduced (TOSCA Monitor; Linde Medical Sensors, Basel, Switzerland). The monitor combines pulse oximetry and PtcCO2 measurement in a single ear sensor, which works at 42°C to enhance blood flow in capillaries below the sensor. Methods. In a prospective, open, nonrandomized study of 60 ill neonates, the new ear sensor for combined assessment of SpO2 and PtcCO2 at 42°C was tested. The sensor was adapted to the ear of a neonate with a Varihesive layer (Conva Tec; Princeton, NJ). Data obtained from the ear sensor were compared with SpO2 Finger/Heel, SaO2, and PaCO2 obtained from arterial blood gas in 30 patients and with a capillary blood gas in an additional 30 patients using Bland Altman bias analysis. Data are presented as median (range). Results. The postconceptional age of the patients was 38.3 weeks (range: 28 5/7-40 5/7) in the arterial group and 37.9 weeks (range: 29 6/7-41 0/7) in the capillary group. Age of the newborns studied was 3.5 days (range: 1-28) in the arterial blood sample group (n = 30) and 6 days (range: 2-28) in the capillary blood sample group (n = 30). Patient weight was 3.02 kg (range: 1.5-4.5) in the arterial group and 2.76 kg (range: 1.0-3.71) in the other group. Three patients had weights of < 1500 g. Twenty-one of 60 patients were conventionally ventilated, 4 patients received high-freque- ncy oscillation, and 35 were not ventilated. Mean difference (bias) and precision (2 SD of the mean difference) between PtcCO2TOSCA and PaCO2 were -0.44 kPa (-3.21 mm Hg) and 0.82 kPa (6.02 mm Hg) and between PtcCO2TOSCA and PcapCO2 were -0.09 kPa (-0.67mm Hg) and 1.11 kPa (8.07 mm Hg), respectively. SpO2 assessment by the TOSCA revealed slightly higher values compared with SaO2 (bias: -0.48%), whereas SpO2Finger/Heel values were slightly lower than SaO2 (bias: 0.52%). Conclusion. The TOSCA monitor with the ear sensor adapted to ears of neonates allows reliable estimation of SaO2 and PaCO2. A potential benefit is the reduction in motion artifacts because of less head movement in new-borns and that onl y a single cable leads form the patient to the monitor. In addition, the sensor is not removed for chest radiograph or for nursing the infant on his or her parent’s lap. Long-term studies in a large population with continuous measurements are required to confirm these preliminary findings and to elucidate the benefits in detection of respiratory deterioration and the potential side effects of this sensor.
文摘目的探索气管内脉搏氧饱和度监测的信号来源,并观察影响信号质量的相关因素。方法将杂种犬麻醉后经口腔插入前端贴附一次性儿童氧饱和度探头的气管导管。开胸直视下,让气管内氧饱和度探头发射的红光对准单侧气管旁大动脉,暂时阻断气管旁大动脉,观察阻断前后经气管脉搏血氧饱和度(SptO2)的脉搏光容积描记(PPG)波形和读数变化。用照片采集SptO2的最佳信号,调节气管导管套囊内压力,观察不同套囊压力下机械通气与否对信号波形和读数的影响,并与来自犬尾的脉搏氧饱和度(SpO2)做比较。结果当气管内氧饱和度探头所对准的气管旁大动脉被阻断时,SptO2的信号消失。机械通气和套囊压力均可使SptO2信号产生变化(P<0.001)。套囊压力为0、10 cm H2O时SptO2信号与套囊压力为20～60 cm H2O时相比差异有统计学意义(P<0.001),机械通气下的SptO2波形与无机械通气时不同(P<0.01),且与SpO2的差异有统计学意义(P<0.01)。结论SptO2的信号主要来自于气管周围的大动脉而非气管壁本身,气管套囊压力与机械通气对SptO2信号的读数均有影响,套囊压力在20～60 cm H2O时比10 cm H2O的SptO2信号更好,机械通气主要影响信号的波形。
