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Published on: January 29, 2011
End-tidal carbon dioxide for monitoring primary closure of gastroschisis
N K Puffinbarger1, D V Taylor, D W Tuggle
1Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, USA.
Insights
Intraoperative end-tidal carbon dioxide (ETCO2) monitoring can guide safe primary abdominal closure for infants with gastroschisis. An ETCO2 level of 50 or higher may indicate that primary closure is unsafe, simplifying post-operative care.
Area of Science:
- Neonatal Surgery
- Pediatric Surgery
- Surgical Outcomes
Background:
- Gastroschisis management traditionally relied on multiple clinical parameters for primary abdominal closure.
- Intraoperative end-tidal carbon dioxide (ETCO2) monitoring was introduced as a standard in 1985.
- Evaluating ETCO2's role in determining closure feasibility is crucial.
Purpose of the Study:
- To assess the impact of intraoperative ETCO2 monitoring on primary abdominal closure in neonates with gastroschisis.
- To identify a specific ETCO2 threshold indicative of potential primary closure failure.
Main Methods:
- Retrospective review of 129 neonates with gastroschisis treated between 1976 and 1993.
- Comparison of outcomes between neonates undergoing closure before and after the implementation of ETCO2 monitoring (1985).
- Analysis of ETCO2 levels in relation to the feasibility of primary abdominal closure.
Main Results:
- No significant differences in overall mortality, birth weight, or postoperative ventilation between the two groups.
- Increased rates of primary closure in the ETCO2 monitoring era (1985-1993), with no conversions to staged procedures.
- An ETCO2 level of ≥50 mmHg was associated with potential primary closure challenges.
Conclusions:
- Intraoperative ETCO2 monitoring provides a reliable method for assessing the safety of primary abdominal closure in gastroschisis.
- This monitoring may eliminate the need for additional invasive assessments during closure.
- ETCO2 monitoring can help optimize surgical decisions for gastroschisis repair.
Abstract:
Previous criteria for primary reduction of the herniated viscera in newborn infants with gastroschisis included intraoperative respiratory rate, cardiac indices, degree of viscero-abdominal disproportion, size of defect, and lower extremity turgor. From 1976 through 1993, 129 neonates with gastroschisis were treated at Children's Hospital of Oklahoma. Intraoperative end-tidal carbon dioxide (ETCO2) monitoring was standard therapy beginning in 1985. The authors evaluated the effect of abdominal closure on ETCO2 to determine if there was a particular ETCO2 level at which closure was not feasible. There was no difference in overall mortality, birth weight, or postoperative ventilation requirements between children who had closure before 1985 (ie, without ETCO2 monitoring) and those who had repair after 1985. However, more cases in the 1985-1993 group had primary closure, and none of these required conversion to a staged procedure. An ETCO2 of > or = 50 suggests that primary closure may be unsafe. These data suggest that infants with gastroschisis can have primary closure based on intraoperative ETCO2 monitoring; no additional invasive monitoring would be necessary to assess closure.
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