Bochanen, M. (Margriet) (2015) Voorspelt transcutaan gemeten hypocapnie cerebrale hypoperfusie? thesis, Medicine.
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Abstract
Background: premature born children are very vulnerable. They often need respiratory care, which is evaluated by measuring the blood gass value of CO2. These values are obtained by bloodpuncturing, which causes a lot of stress and has several disadvantages. An alternative non-invasive method would be desirable. In this study, we investigated the use of transcutaneous measuring of CO2. It is known that hypocania measured by blood gasses predicts cerebral hypoperfusion. It is not known whether transcutaneous measured hypocapnia predicts the same. Aim: the aim of this study is to evaluate the relationship between tcCO2 and cerebral bloodflow, measured using NIRS, on the third day postnatally in extreme premature born children. Methods: we included preterm infants with a gestational age between 24+0/7 and 26+6/7 weeks, born between January 2011 and November 2014 who were admitted to the NICU of the UMCG directly after birth. Data of rcSO2, tcCO2, SpO2 and pCO2 were collected from different (online) databases and medical files at two moments (morning and evening). We calculated the FTOE as a marker of hypoxia-ischemia. We used IBM SPSS Statistics 22 for the statistical analyses. Results: 51 children were included (mean gestation age 26.0 ± SD 0.76 weeks; median birth weight 845 grams (525-1110 grams)). We found a negative correlation between tcCO2 and FTOE (rho = -0.383; p = 0.06). The agreement between pCO2 and tcCO2 was moderate. However, there was a strong correlation between pCO2 and tcCO2 (rho = 0.786; p = <0.001) and between ΔpCO2 and ΔtcCO2 (rho=0,700; p=0,018). Negative trends were found for the correlation between ΔpCO2 and ΔFTOE (rho=-0,544; p=0,065) and for the correlation between ΔtcCO2 and ΔFTOE (rho=-0,265; p=0,054). Type of ventilation had a significant influence on the FTOE when taking into account the tcCO2 and gestational age. tcCO2 increases with increasing postnatal age. Conclusion: transcutaneous measured hypocapnia predicts cerebral hypoperfusion. Despite a difference with the golden standard pCO2, a relation between tcCO2 and cerebral bloodflow has been found. This suggests that the tcCO2 can help to estimate whether cerebral bloodflow is compromised as a result of low CO2. Further research with a larger study population would be useful, as well as taking into account the degree of illness, use of medication and perfusion of the skin.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Kooi, Dr. Elisabeth M.W. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:40 |
| Last Modified: | 25 Jun 2020 10:40 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/180 |
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