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Continuous end-tidal CO2 in pediatric bronchoscopy
L M Franchi1, J C Maggi, E Nussbaum
1Memorial Miller Children's Hospital, Department of Pediatrics, University of California, Irvine, Long Beach 90801-1428.
Insights
Flexible fiberoptic bronchoscopy (FFB) in children can cause decreases in end-tidal PCO2 (PetCO2) and SpO2, even with oxygen. PetCO2 changes may predict SpO2 drops, suggesting airway obstruction during FFB.
Area of Science:
- Pediatric Pulmonology
- Respiratory Physiology
- Medical Devices
Background:
- Flexible fiberoptic bronchoscopy (FFB) is utilized for pediatric diagnostic and therapeutic procedures.
- Sedation and instrument insertion during FFB can compromise ventilation, potentially causing hypoxemia and desaturation.
- Current monitoring typically relies on pulse oximetry (SpO2), with end-tidal PCO2 (PetCO2) not routinely employed.
Purpose of the Study:
- To prospectively evaluate changes in PetCO2 and SpO2 during FFB in pediatric patients.
- To investigate the relationship between PetCO2 and SpO2 variations during the procedure.
- To explore the potential utility of PetCO2 monitoring in pediatric FFB.
Main Methods:
- Twenty-two pediatric patients (15 days to 18 years) undergoing FFB with supplemental oxygen were studied.
- Continuous measurements of PetCO2 and SpO2 were recorded before and during FFB.
- Data analysis focused on changes in mean PetCO2 and SpO2 levels and their temporal relationship.
Main Results:
- Mean PetCO2 decreased significantly from 33.9 mmHg to 27.1 mmHg during FFB (P < 0.024).
- Mean SpO2 also decreased significantly from 99.9% to 95.7% during FFB (P < 0.015).
- PetCO2 changes appeared to precede SpO2 variations, particularly in younger patients experiencing desaturation.
Conclusions:
- Both PetCO2 and SpO2 decrease during FFB in children, even with supplemental oxygen.
- The observed decreases may indicate airway obstruction by the bronchoscope.
- Further research is warranted to determine the clinical value of PetCO2 monitoring in pediatric FFB.
Abstract:
In recent years flexible fiberoptic bronchoscopy (FFB) has been applied to children for diagnostic and therapeutic purposes. Sedation during FFB, along with introduction of the bronchoscope into the pediatric airway, may cause hypoventilation, leading to hypoxia and desaturation, even in the presence of oxygen supplementation. Arterial oxygen saturation is usually monitored by pulse oximetry (SpO2) during FFB. End-tidal PCO2 (P(etCO2)) monitoring is not routinely used. Twenty-two pediatric patients (15 days to 18 years old) undergoing FFB and receiving supplemental oxygen were studied prospectively and had continuous P(etCO2) and SpO2 measured before and during the procedure (bronchoscope at the carina or either main bronchus). Mean P(etCO2) (+/- SD) decreased from 33.9 (+/- 6.0) mmHg before to 27.1 (+/- 12.1) mmHg during the procedure (P < 0.024). Concomitantly, mean SpO2 (+/- SD) also decreased from 99.9 (+/- 0.4)% before to 95.7 (+/- 11.1)% during the procedure (P < 0.015). P(etCO2) changes seemed to precede the variations in SpO2, especially in young patients who experienced significant desaturation and decompensation during FFB. We conclude that PetCO2 and SpO2 decrease during FFB in children, even with supplemental oxygen. We speculate that this reflects airway obstruction by the instrument. Further studies are needed to assess the utility of PetCO2 monitoring in pediatric FFB.