Abstract
Background:
We hypothesized that implementation of end tidal carbon dioxide (ETCO2) continuous monitoring did not change the number of blood gases obtained after low risk cardiac surgery. In 2015, we implemented ETCO2 monitoring in our Cardiac Intensive Care Unit (CICU). Implementation included education about use of ETCO2, calibration and physiologic circumstances associated with differences between blood levels of carbon dioxide and ETCO2 monitoring.
Methods:
Retrospective chart review of neonatal patients U30 days who underwent lateral thoracic coarctation repair before and after implementation of continuous ETCO2 monitoring. Inclusion criteria were patients mechanically ventilated who had >3 postoperative blood gases. Patients who had >2 comorbidities involving >1 organ system, emergent surgery, diagnosis of pulmonary hypertension or need for inhaled nitric oxide post-procedure were excluded.
Results:
A total of 26 patients were identified (13 pre, 13 post-intervention). Patients were similar in age, gender, prematurity, presentation, hospital and CICU length of stay. A total of 98 blood gases were performed postoperatively in the pre-ETCO2 group (average 8/patient) and a total of 57 blood gases in the post group (average 4/patient). When the cohort was limited to patients with a hospital stay of U15 days, the total number of postoperative blood gases in pre-ETCO2 group (n=10) was 61 (average 6/patient) and post (n=12) 51 (average 4/patient), P=0.006.
Conclusions:
In a matched cohort, the presence of continuous ETCO2 monitoring and education about use of monitors decreased the total number of blood gases obtained, thus leading to a decrease in patient cost, blood loss and potential risk of line infection.
n= total patients, IQR= interquartile range, LOS= length of stay View all access options for this article.Table
Demographics
Pre-ETCO2(n=13)
Post-ETCO2(n=13)
P
Age (days) median (IQR)
5 (4, 13)
5 (5, 8)
0.76
Female n (%)
7 (54)
3 (23)
0.11
Prematurity n (%)
3 (23)
3 (23)
1.00
Prenatal diagnosis n (%)
5 (39)
2 (15)
0.34
Symptomatic n (%)
1 (8)
2 (23)
0.59
Other cardiac findings n (%)
10 (77%)
10 (77%)
1.00
Ventilation time (minutes) median (IQR)
1460 (1132, 2080)
1395 (1267, 1535)
0.69
CICU LOS (days) median (IQR)
3 (3, 5)
4 (3, 5)
0.14
Hospital LOS (days) median (IQR)
11 (7, 17)
6 (5, 11)
0.13
Total blood gases median (IQR)
7 (6, 8)
4 (3, 6)
0.001
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