Transcutaneous Carbon Dioxide Monitoring During Apnea Testing for Determination of Neurologic Death in Children: A Retrospective Case Series*

Objectives: Determination of neurologic death in children is a clinical diagnosis based on absence of neurologic function with irreversible coma and apnea. Apnea testing during determination of neurologic death assesses spontaneous respiration when Paco2 increases to greater than or equal to 60 and greater than or equal to 20 mm Hg above pre-apneic baseline. The utility of transcutaneous carbon dioxide measurements during apnea testing in children is unknown. We seek to determine the degree of correlation between paired transcutaneous carbon dioxide and Paco2 values during apnea testing for determination of neurologic death. Design: Single-center, retrospective case series. Setting: Twenty-eight bed PICU in a 259-bed, tertiary care, referral center. Patients: Children 0–18 years old undergoing determination of neurologic death between May 2017 and December 2018. Interventions: None. Measurements and Main Results: Primary outcomes were paired transcutaneous carbon dioxide and Paco2 values obtained during determination of neurologic death. Primary analyses included Pearson correlation coefficient, Bland-Altman bias and limits of agreement, and comparative statistics. Descriptive data included demographics, admission diagnoses, hemodynamics, Vasoactive Inotropic Scores, and arterial blood gas measurement. Eight children underwent 15 determination of neurologic death examinations resulting in 31 paired transcutaneous carbon dioxide and Paco2 values for study. T...
Source: Pediatric Critical Care Medicine - Category: Pediatrics Tags: Neurocritical Care Source Type: research