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Alveolar ventilation in children during flexible bronchoscopy
Efraim Sadot1, Guy Gut2, Yakov Sivan2
1Tel Aviv University Sackler Faculty of Medicine, Department of Pediatric Pulmonary, Critical Care and Sleep Medicine, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel. efraims@tlvmc.gov.il.
Pediatric Pulmonology
|April 11, 2016
Summary
A significant number of children undergoing flexible bronchoscopy (FB) experience alveolar hypoventilation, indicated by elevated transcutaneous carbon dioxide (TcCO2) levels. Monitoring TcCO2 during FB is feasible and recommended, especially for patients receiving heavy sedation.
Area of Science:
- Pediatric Pulmonology
- Anesthesiology
- Respiratory Physiology
Background:
- Flexible bronchoscopy (FB) in children can lead to hypoxia and hypercarbia.
- Alveolar ventilation is not routinely monitored during FB, unlike oxygenation.
- Transcutaneous carbon dioxide (TcCO2) monitoring offers a potential solution for assessing ventilation.
Purpose of the Study:
- To investigate alveolar ventilation in children during FB.
- To measure carbon dioxide (CO2) levels using the transcutaneous technique during FB.
- To assess the feasibility and implications of TcCO2 monitoring in pediatric FB.
Main Methods:
- Ninety-five children undergoing FB were recruited.
- Transcutaneous CO2 (TcCO2) levels were continuously recorded alongside routine monitoring.
- A standardized sedation protocol was applied to all participants.
Main Results:
- A significant rise in TcCO2, indicating hypoventilation, was observed in a large proportion of children.
- Higher peak TcCO2 and greater TcCO2 rise were associated with higher propofol doses (>3.5 mg/kg).
- No correlation was found between TcCO2 changes and patient age, weight, bronchoscope size, or diagnosis.
Conclusions:
- A substantial percentage of children undergoing FB exhibit alveolar hypoventilation, evidenced by increased TcCO2.
- TcCO2 monitoring is a feasible method to assess ventilation during FB.
- TcCO2 monitoring is particularly valuable in high-risk patients, including those requiring significant sedation or susceptible to respiratory acidosis.
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