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Transcutaneous oxygen monitoring beyond the neonatal period
1Hospital for Sick Children, Institute of Child Health, London, United Kingdom.
Insights
Transcutaneous oxygen (PtcO2) monitoring accurately reflects arterial oxygen (PaO2) levels in infants and children. A 44°C electrode temperature allows for safe, extended monitoring periods up to 8 hours.
Area of Science:
- Pediatric Pulmonology
- Medical Device Technology
- Clinical Monitoring
Background:
- Transcutaneous oxygen (PtcO2) monitoring is a non-invasive method to assess tissue oxygenation.
- Accurate correlation between PtcO2 and arterial oxygen (PaO2) is crucial for clinical decision-making in pediatric patients.
- Optimizing PtcO2 measurement conditions can enhance its reliability and clinical utility.
Purpose of the Study:
- To evaluate the relationship between transcutaneous oxygen (PtcO2) and arterial oxygen (PaO2) in infants and children at different electrode temperatures.
- To assess the impact of skin preparation and extended monitoring durations on PtcO2 accuracy.
- To determine optimal parameters for reliable PtcO2 monitoring in pediatric populations.
Main Methods:
- Compared PtcO2 and PaO2 measurements in 57 infants and children (2 wk to 15.5 yr) using electrode temperatures of 43°C and 44°C.
- Investigated the effect of skin stripping on PtcO2/PaO2 correlation.
- Applied a correction factor for transepidermal O2 loss at 44°C in 20 children with sleep-disordered breathing.
- Monitored safety and skin integrity over extended periods (up to 8 hours).
Main Results:
- Linear relationships between PtcO2 and PaO2 were observed at both 43°C and 44°C across a wide PaO2 range (39.75 to 120 torr).
- Skin stripping did not improve the PtcO2/PaO2 correlation.
- A correction factor at 44°C yielded a mean PtcO2/PaO2 ratio of 0.99, indicating effective arterialization.
- Extended monitoring up to 8 hours between site changes did not cause skin burns or persistent erythema.
Conclusions:
- Transcutaneous oxygen (PtcO2) is a reliable non-invasive measure of PaO2 in hemodynamically stable infants and children at electrode temperatures of 43°C and 44°C.
- Utilizing a 44°C electrode temperature with an air calibration correction factor allows for effective arterialization and extended monitoring.
- Safe and reliable PtcO2 monitoring can be achieved by extending site change intervals to 8 hours at 44°C.
Abstract:
Transcutaneous O2 (PtcO2) tensions were compared with PaO2 measurements in 57 infants and children (age range 2 wk to 15.5 yr) using electrode temperatures of 43 degrees and 44 degrees C. At both temperatures, the relationships between PtcO2 and PaO2 were linear over the whole range of data (PaO2 39.75 to 120 torr) although mean PtcO2/PaO2 fell from 44 degrees to 43 degrees C. Skin stripping by repeated applications of adhesive tape immediately before electrode placement did not improve these relationships. In an additional 20 children with a mean age of 2.4 yr (range 0.08 to 15.85) who were being investigated for sleep-disordered breathing, the mean PaO2/PtcO2 ratio of 1.22 at 44 degrees C was used as a correction factor during air calibration for PtcO2. This resulted in a mean PtcO2/PaO2 of 0.99 (range 0.83 to 1.15) provided blood flow is not impaired. Extending the monitoring period from 4 to 8 h between site changes did not result in any burns or persisting erythema. In hemodynamically stable infants and children, and at electrode temperatures of 44 degrees C and 43 degrees C, PtcO2 is linearly related to PaO2 over a wide range of PaO2 values. At an electrode temperature of 44 degrees C, PtcO2 can be arterialized effectively by allowing for transepidermal O2 loss during air calibration; at this electrode temperature, intervals between site changes can be extended safely up to 8 h.