• Jan J van Wijk, Norani H Gangaram-Panday, Willem van Weteringen, Bas Pullens, Simone E Bernard, Sanne E Hoeks, ReissIrwin K MIKMDepartment of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands., Robert J Stolker, and Lonneke M Staals.
• Department of Anesthesiology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands. Electronic address: j.j.vanwijk@erasmusmc.nl.
• J Clin Anesth. 2025 Jan 1; 100: 111692111692.

Study ObjectiveDuring rigid bronchoscopies and microlaryngeal surgery (MLS) in children, there is currently no reliable method for managing ventilation strategies based on carbon dioxide (CO2) levels. This study aimed to investigate the effects of the clinical implementation of transcutaneous CO2 (tcPCO2) monitoring during rigid bronchoscopies or MLS.DesignProspective observational study.SettingOperating theatre of a tertiary pediatric hospital, from January 2019 to March 2021.PatientsChildren with an age < 18 years, undergoing rigid bronchoscopy or MLS, were eligible for inclusion. Children with tracheostomy and/or skin conditions limiting tcPCO2 monitoring were excluded.InterventionsTcPCO2 monitoring was performed in two groups; blinded before clinical implementation (control group) and visible for ventilation management after clinical implementation (tcPCO2 group).MeasurementsThe total tcPCO2 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 tcPCO2 group received a questionnaire after each procedure.Main ResultsA 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 tcPCO2 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 tcPCO2 group. Spontaneous breathing was associated with lower tcPCO2 levels. The general satisfaction score of tcPCO2 monitoring rated by the anesthesiologist was 8.19 (0.96).ConclusionsTcPCO2 levels reached approximately twice the upper limit of the normal range during rigid bronchoscopy and MLS. Availability of tcPCO2 monitoring did not affect these high levels, despite adjustments in strategy. However, tcPCO2 monitoring provides valuable insight in CO2 load and applied ventilation strategies.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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