Monitoring Gas Exchange During Hypothermia for Hypoxic-Ischemic Encephalopathy

Bushra Afzal, Praveen Chandrasekharan, Daniel J Tancredi, James Russell, Robin H Steinhorn, Satyanarayana Lakshminrusimha

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

OBJECTIVES: Therapeutic hypothermia is standard of care in management of moderate/severe hypoxic-ischemic encephalopathy. Persistent pulmonary hypertension of the newborn is associated with hypoxic-ischemic encephalopathy and is exacerbated by hypoxemia and hypercarbia. Gas exchange is assessed by arterial blood gas analysis (with/without correction for body temperature), pulse oximetry, and end-tidal CO2. DESIGN: A retrospective chart review. SETTINGS: Regional perinatal center in Western New York. PATIENTS: Fifty-eight ventilated neonates with indwelling arterial catheter on therapeutic hypothermia.None. MEASUREMENT AND MAIN RESULTS: We compared pulse oximetry, PaO2, end-tidal CO2, and PaCO2 during hypothermia and normothermia in neonates with hypoxic-ischemic encephalopathy using 1,240 arterial blood gases with simultaneously documented pulse oximetry. During hypothermia, pulse oximetry 92-98% was associated with significantly lower temperature-corrected PaO2 (51 mmHg; interquartile range, 43-51) compared with normothermia (71 mmHg; interquartile range, 61-85). Throughout the range of pulse oximetry values, geometric mean PaO2 was about 23% (95% CI, 19-27%) lower during hypothermia compared with normothermia. In contrast, end-tidal CO2 accurately assessed temperature-corrected PaCO2 during normothermia and hypothermia. CONCLUSIONS: Hypothermia shifts oxygen-hemoglobin dissociation curve to the left resulting in lower PaO2 for pulse oximetry. Monitoring oxygenation with arterial blood gas uncorrected for body temperature and pulse oximetry may underestimate hypoxemia in hypoxic-ischemic encephalopathy infants during whole-body hypothermia, while end-tidal CO2 reliably correlates with temperature-corrected PaCO2.

Fingerprint

Brain Hypoxia-Ischemia
Oximetry
Hypothermia
Gases
Induced Hypothermia
Body Temperature
Temperature
Persistent Fetal Circulation Syndrome
Newborn Infant
Blood Gas Analysis
Indwelling Catheters
Hypercapnia
Standard of Care
Hemoglobins
Oxygen

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

@article{67b4de7ce5c2429cacd0350fefd29f4b,
title = "Monitoring Gas Exchange During Hypothermia for Hypoxic-Ischemic Encephalopathy",
abstract = "OBJECTIVES: Therapeutic hypothermia is standard of care in management of moderate/severe hypoxic-ischemic encephalopathy. Persistent pulmonary hypertension of the newborn is associated with hypoxic-ischemic encephalopathy and is exacerbated by hypoxemia and hypercarbia. Gas exchange is assessed by arterial blood gas analysis (with/without correction for body temperature), pulse oximetry, and end-tidal CO2. DESIGN: A retrospective chart review. SETTINGS: Regional perinatal center in Western New York. PATIENTS: Fifty-eight ventilated neonates with indwelling arterial catheter on therapeutic hypothermia.None. MEASUREMENT AND MAIN RESULTS: We compared pulse oximetry, PaO2, end-tidal CO2, and PaCO2 during hypothermia and normothermia in neonates with hypoxic-ischemic encephalopathy using 1,240 arterial blood gases with simultaneously documented pulse oximetry. During hypothermia, pulse oximetry 92-98{\%} was associated with significantly lower temperature-corrected PaO2 (51 mmHg; interquartile range, 43-51) compared with normothermia (71 mmHg; interquartile range, 61-85). Throughout the range of pulse oximetry values, geometric mean PaO2 was about 23{\%} (95{\%} CI, 19-27{\%}) lower during hypothermia compared with normothermia. In contrast, end-tidal CO2 accurately assessed temperature-corrected PaCO2 during normothermia and hypothermia. CONCLUSIONS: Hypothermia shifts oxygen-hemoglobin dissociation curve to the left resulting in lower PaO2 for pulse oximetry. Monitoring oxygenation with arterial blood gas uncorrected for body temperature and pulse oximetry may underestimate hypoxemia in hypoxic-ischemic encephalopathy infants during whole-body hypothermia, while end-tidal CO2 reliably correlates with temperature-corrected PaCO2.",
author = "Bushra Afzal and Praveen Chandrasekharan and Tancredi, {Daniel J} and James Russell and Steinhorn, {Robin H} and Satyanarayana Lakshminrusimha",
year = "2019",
month = "2",
day = "1",
doi = "10.1097/PCC.0000000000001799",
language = "English (US)",
volume = "20",
pages = "166--171",
journal = "Pediatric Critical Care Medicine",
issn = "1529-7535",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Monitoring Gas Exchange During Hypothermia for Hypoxic-Ischemic Encephalopathy

AU - Afzal, Bushra

AU - Chandrasekharan, Praveen

AU - Tancredi, Daniel J

AU - Russell, James

AU - Steinhorn, Robin H

AU - Lakshminrusimha, Satyanarayana

PY - 2019/2/1

Y1 - 2019/2/1

N2 - OBJECTIVES: Therapeutic hypothermia is standard of care in management of moderate/severe hypoxic-ischemic encephalopathy. Persistent pulmonary hypertension of the newborn is associated with hypoxic-ischemic encephalopathy and is exacerbated by hypoxemia and hypercarbia. Gas exchange is assessed by arterial blood gas analysis (with/without correction for body temperature), pulse oximetry, and end-tidal CO2. DESIGN: A retrospective chart review. SETTINGS: Regional perinatal center in Western New York. PATIENTS: Fifty-eight ventilated neonates with indwelling arterial catheter on therapeutic hypothermia.None. MEASUREMENT AND MAIN RESULTS: We compared pulse oximetry, PaO2, end-tidal CO2, and PaCO2 during hypothermia and normothermia in neonates with hypoxic-ischemic encephalopathy using 1,240 arterial blood gases with simultaneously documented pulse oximetry. During hypothermia, pulse oximetry 92-98% was associated with significantly lower temperature-corrected PaO2 (51 mmHg; interquartile range, 43-51) compared with normothermia (71 mmHg; interquartile range, 61-85). Throughout the range of pulse oximetry values, geometric mean PaO2 was about 23% (95% CI, 19-27%) lower during hypothermia compared with normothermia. In contrast, end-tidal CO2 accurately assessed temperature-corrected PaCO2 during normothermia and hypothermia. CONCLUSIONS: Hypothermia shifts oxygen-hemoglobin dissociation curve to the left resulting in lower PaO2 for pulse oximetry. Monitoring oxygenation with arterial blood gas uncorrected for body temperature and pulse oximetry may underestimate hypoxemia in hypoxic-ischemic encephalopathy infants during whole-body hypothermia, while end-tidal CO2 reliably correlates with temperature-corrected PaCO2.

AB - OBJECTIVES: Therapeutic hypothermia is standard of care in management of moderate/severe hypoxic-ischemic encephalopathy. Persistent pulmonary hypertension of the newborn is associated with hypoxic-ischemic encephalopathy and is exacerbated by hypoxemia and hypercarbia. Gas exchange is assessed by arterial blood gas analysis (with/without correction for body temperature), pulse oximetry, and end-tidal CO2. DESIGN: A retrospective chart review. SETTINGS: Regional perinatal center in Western New York. PATIENTS: Fifty-eight ventilated neonates with indwelling arterial catheter on therapeutic hypothermia.None. MEASUREMENT AND MAIN RESULTS: We compared pulse oximetry, PaO2, end-tidal CO2, and PaCO2 during hypothermia and normothermia in neonates with hypoxic-ischemic encephalopathy using 1,240 arterial blood gases with simultaneously documented pulse oximetry. During hypothermia, pulse oximetry 92-98% was associated with significantly lower temperature-corrected PaO2 (51 mmHg; interquartile range, 43-51) compared with normothermia (71 mmHg; interquartile range, 61-85). Throughout the range of pulse oximetry values, geometric mean PaO2 was about 23% (95% CI, 19-27%) lower during hypothermia compared with normothermia. In contrast, end-tidal CO2 accurately assessed temperature-corrected PaCO2 during normothermia and hypothermia. CONCLUSIONS: Hypothermia shifts oxygen-hemoglobin dissociation curve to the left resulting in lower PaO2 for pulse oximetry. Monitoring oxygenation with arterial blood gas uncorrected for body temperature and pulse oximetry may underestimate hypoxemia in hypoxic-ischemic encephalopathy infants during whole-body hypothermia, while end-tidal CO2 reliably correlates with temperature-corrected PaCO2.

UR - http://www.scopus.com/inward/record.url?scp=85061037062&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061037062&partnerID=8YFLogxK

U2 - 10.1097/PCC.0000000000001799

DO - 10.1097/PCC.0000000000001799

M3 - Article

VL - 20

SP - 166

EP - 171

JO - Pediatric Critical Care Medicine

JF - Pediatric Critical Care Medicine

SN - 1529-7535

IS - 2

ER -