부산대학교 도서관

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1399-5448.2006.00186.x Byline: Michael SD Agus (a), Jamin L Alexander (a), Patricia A Mantell (b) Keywords: capnography; diabetic ketoacidosis; human; metabolic acidosis; physiologic monitoring Abstract: Introduction: Pediatric inpatients with diabetic ketoacidosis (DKA) are routinely subjected to frequent blood draws in order to closely monitor degree of acidosis and response to therapy. The typical level of acidosis monitoring is less than ideal, however, because of the high cost and invasiveness of frequent blood labs. Previous studies have validated end-tidal carbon dioxide (EtCO.sub.2) monitoring in the emergency department (ED) for varying periods of time. We extend these findings to the inpatient portion of the hospitalization during which the majority of blood tests are sent. Methods: All patients admitted to an intermediate care unit in (InCU) a large children's hospital were fitted with an appropriately sized oral/nasal cannula capable of sensing EtCO.sub.2. Laboratory studies were obtained according to hospital clinical practice guidelines. In a retrospective analysis, EtCO.sub.2 values were correlated with serum total CO.sub.2 (stCO.sub.2), venous pH (vpH), venous pCO.sub.2 (vpCO.sub.2), and calculated bicarbonate from venous blood gas (vHCO.sub.3.sup.-). Results: A total of 78 consecutive episodes of DKA in 72 patients aged 1-21 yr were monitored for 3-38 h with both capnography and laboratory testing, producing 334 comparisons. Initial values were as follows, reported as median (range): stCO.sub.2, 11 (4-22) mmol/L; vpH, 7.281 (6.998-7.441); vpCO.sub.2, 28.85 (9.3-43.3) mmHg; and vHCO.sub.3.sup.-, 14 (3-25) mmol/L. EtCO.sub.2 was correlated well with stCO.sub.2 (r = 0.84, p < 0.001), vHCO.sub.3.sup.- (r = 0.84, p < 0.001), and vpCO.sub.2 (r = 0.79, p < 0.001). Conclusions: These data support the findings of previous studies limited to ED populations and suggest that non-invasive EtCO.sub.2 monitoring is a valuable and reliable tool to continuously follow acidosis in the setting of the acutely ill pediatric patient with DKA. Continuous EtCO2 monitoring offers the practitioner an early warning system for unexpected changes in acidosis that augments the utility of intermittent blood gas determinations. Author Affiliation: (a)Division of Endocrinology, Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA (b)Department of Nursing, Children's Hospital, Boston, Boston, MA, USA Article History: Submitted 11 October 2005. Accepted for publication 24 May 2006 Article note: Michael SD Agus, MD, Division of Endocrinology, Department of Medicine, Children's Hospital Boston, Main 9 South, 300 Longwood Avenue, Boston, MA 02115, USA., Tel: 617-355-5849; fax: 617-344-2565; e-mail: michael.agus@childrens.harvard.edu