Journal article
Transient End-Tidal Carbon Dioxide Elevation During Pediatric Upper Endoscopy With Carbon Dioxide Insufflation: Is It True Hypercapnia?
Journal of pediatric gastroenterology and nutrition, Vol.74(3), pp.413-418
03/01/2022
DOI: 10.1097/MPG.0000000000003363
PMID: 34856563
Abstract
Background: Endoscopic insufflation, long performed using air, is being replaced by carbon dioxide (CO2) at many pediatric centers, despite limited published data on its use in children. We have previously demonstrated that CO2 use during esophagogastroduodenoscopy (EGD) in non-intubated children is associated with transient elevations of end-tidal CO2 (EtCO2). This observation raised concerns about possible CO2 inhalation and systemic absorption. Here, we investigate this concern by concurrently measuring both EtCO2 and transcutaneous CO2 (tCO(2)) during upper endoscopic procedures in children. Aim: To determine if elevations in EtCO2 levels seen in non-intubated children undergoing CO2 insufflation during EGD are associated with elevated systemic CO2 levels. Methods: Double-blinded, prospective, randomized clinical trial. Children were randomized 1:1 to receive either CO2 or air for endoscopic insufflation. EtCO2 was sampled with a CO2-sampling nasal cannula and tCO(2) was monitored using the Radiometer transcutaneous monitoring device. Results: Fifty nine patients were enrolled; 30 patients in the CO2 insufflation group and 29 in the air group. All patients underwent a procedure involving an EGD. Transient elevations in EtCO2 (defined as >60 mmHg) were observed only in the CO2 insufflation group. This contrasted with the similar elevations of tCO(2) between the CO2 and air insufflation groups. None of these events were of clinically significant magnitude or duration. Conclusion: This study demonstrates that the observed transient elevations in EtCO2 seen during EGD in non-intubated children receiving CO2 insufflation are most likely measurements of eructated CO2 without evidence of excessive systemic absorption of CO2.
Details
- Title: Subtitle
- Transient End-Tidal Carbon Dioxide Elevation During Pediatric Upper Endoscopy With Carbon Dioxide Insufflation: Is It True Hypercapnia?
- Creators
- Chinenye R. Dike - University of IowaWarren P. Bishop - University of IowaSarah S. Titler - University of IowaRiad Rahhal - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of pediatric gastroenterology and nutrition, Vol.74(3), pp.413-418
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/MPG.0000000000003363
- PMID
- 34856563
- ISSN
- 0277-2116
- eISSN
- 1536-4801
- Number of pages
- 6
- Language
- English
- Date published
- 03/01/2022
- Academic Unit
- Stead Family Department of Pediatrics; Anesthesia; Gastroenterology, Hepatology, Pancreatology, and Nutrition
- Record Identifier
- 9984296148502771
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