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. 2025 May;60(5):e71115.
doi: 10.1002/ppul.71115.

Transcutaneous Carbon Dioxide Monitoring During Weaning From Mechanical Ventilation in Children: The WeanCO2 Study

Meryl Vedrenne-Cloquet  1   2   3 , Charlotte Collignon  1 , Noémie De Cacqueray  1 , Mathilde Grapin  4 , Mehdi Oualha  1   3 , Sylvain Renolleau  1   3 , Lucie Griffon  2   3 , Sonia Khirani  2   3   5 , Brigitte Fauroux  2   3
Affiliations

Transcutaneous Carbon Dioxide Monitoring During Weaning From Mechanical Ventilation in Children: The WeanCO2 Study

Meryl Vedrenne-Cloquet et al. Pediatr Pulmonol. 2025 May.

Abstract

Introduction: Spontaneous breathing trial (SBT) is recommended during weaning from mechanical ventilation (MV), but objective and easy tools lack to identify pediatric weaning failure. We aimed to assess whether changes in estimated arterial CO₂ (PaCO₂) derived from transcutaneous measurements (PTCCO₂) were associated with pediatric weaning failure.

Methods: Children (age 72 h -18 years) with MV > 12 h were continuously monitored using a transcutaneous sensor to estimate PaCO₂ from skin CO₂ tension (PTCCO₂). Values were recorded during SBT (30 min on positive end-expiratory pressure (PEEP) +5 cmH2O, with pressure support of +5 cmH2O for endotracheal tubes with internal diameter ≤ 3.5 mm), then up to 6 h after extubation. Mean PTCCO2 and PTCCO2 changes during SBT, and after extubation, were retrospectively collected to evaluate their association with SBT failure and extubation failure (reintubation within 48 h).

Results: Eighty children (median [IQR] age 1.1 [0.3; 8.7] years) were included, with 89 SBT (14 failures, 75 successes). Sixty-four patients were extubated following their first SBT, with 10 (16%) extubation failures. PTCCO2 changes were not associated with SBT and extubation failures. Patients who failed extubation had a higher mean PTCCO2 value after extubation as compared to those who were successfully extubated (mean PTCCO2 of 51.8 [46.2; 55.4] vs. 42.3 [37.5; 47.2] mmHg, p = 0.02). The difference between the maximal PTCCO2 value within the 2 h following extubation and the value at extubation were higher in patients who failed extubation (ΔPTCCO2 of 20 [9.1; 26] vs. 6.8 [2.9; 9.7] mmHg, p < 10-2).

Conclusion: Early post-extubation increase in estimated PaCO₂ was associated with extubation failure, whereas PTCCO₂ changes during SBT were not.

Keywords: children; extubation; mechanical ventilation; spontaneous breathing trial; transcutaneous carbon dioxide.

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Conflict of interest statement

M. Vedrenne‐Cloquet reports a loan of a PTCCO2 monitoring device from Sentec to conduct the study, with no influence on the study protocol or the results. The other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Evolution of PTCCO2 changes during SBT and after extubation. Vertical light blue lines represent each time point for PTCCO2 evaluation. The two panels correspond to the recordings of 2 different SBT (of two different patients). In panel (A) PTCCO2 value at the onset of the SBT is the maximal value, leading to the same absolute value for SBT‐ΔPTCCO2 max‐min and SBT‐ΔPTCCO2 max‐T0SBT, but to a negative value for SBT‐ΔPTCCO2 max‐T0SBT PTCCO2 value at T0SBT being higher than at the end of the SBT. In Panel (B) PTCCO2 value at extubation is also the minimal value, leading to the same calculations for Ext‐ΔPTCCO2 max‐min and max‐TEXT. H2, end of the 2‐h period after extubation; H6, end of the 6‐h period after extubation; SBT, spontaneous breathing trial; T0SBT, onset of the SBT; TfinSBT, end of the SBT; TEXT, extubation time. [Color figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Flow‐chart of the population. ENT, nose and throat surgeon; ERT, extubation readiness test; SBT, spontaneous breathing trial; PTCCO2, transcutaneous carbon dioxide pressure.
Figure 3
Figure 3
Evolution of patients after the first spontaneous breathing trial (SBT).
See this image and copyright information in PMC

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