Study Objective: During rigid bronchoscopies and microlaryngeal surgery (MLS) in children, there is currently no reliable method for managing ventilation strategies based on carbon dioxide (CO) levels. This study aimed to investigate the effects of the clinical implementation of transcutaneous CO (tcPCO) monitoring during rigid bronchoscopies or MLS.
Design: Prospective observational study.
Setting: Operating theatre of a tertiary pediatric hospital, from January 2019 to March 2021.
Patients: Children with an age < 18 years, undergoing rigid bronchoscopy or MLS, were eligible for inclusion. Children with tracheostomy and/or skin conditions limiting tcPCO monitoring were excluded.
Interventions: TcPCO monitoring was performed in two groups; blinded before clinical implementation (control group) and visible for ventilation management after clinical implementation (tcPCO group).
Measurements: The total tcPCO load outside of the normal range (35-48 mm Hg) was calculated as the area under the curve (AUC) and compared between the groups. Anesthesiologists in the tcPCO group received a questionnaire after each procedure.
Main Results: A total of 120 patients were included. No significant differences were found between the two groups in the AUC during the procedure (19,202 (7,863-44,944) vs 17,737 (9,800-47,566) mm Hg · s, P = 0.84) or between different ventilation strategies. The maximal tcPCO level was 69.2 (62.1-81.2) mm Hg in the control group and 71.1 (62.8-80.8) mm Hg, (P = 0.85) in the tcPCO group. Spontaneous breathing was associated with lower tcPCO levels. The general satisfaction score of tcPCO monitoring rated by the anesthesiologist was 8.19 (0.96).
Conclusions: TcPCO levels reached approximately twice the upper limit of the normal range during rigid bronchoscopy and MLS. Availability of tcPCO monitoring did not affect these high levels, despite adjustments in strategy. However, tcPCO monitoring provides valuable insight in CO load and applied ventilation strategies.
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