Trial reportBMC anesthesiology2026
Reliability of end-tidal carbon dioxide as a surrogate for arterial carbon dioxide assessment in infants undergoing thoracoscopic surgery with one-lung ventilation.
Trial report in BMC anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
backgroundThe reliability of end-tidal carbon dioxide (EtCO₂) as a surrogate for arterial arterial carbon dioxide partial pressure (PaCO₂) during one-lung ventilation (OLV) in infants is uncertain. This study evaluated EtCO₂-PaCO₂ agreement in infants undergoing OLV and identified factors associated with clinically significant discrepancy.
methodsThis secondary analysis of a prospective, randomized controlled trial included 172 infants (aged ≤ 2 years) undergoing thoracoscopic surgery. Paired PaCO₂ and EtCO₂ measurements were obtained 20 min after initiating OLV. Clinical agreement was defined a priori as an absolute difference of ≤ 5 mmHg. Statistical evaluations included Bland-Altman analysis and multivariable logistic regression to identify predictors of disagreement, and correlation analyses.
resultsDuring OLV, the mean EtCO₂-PaCO₂ bias was 2.8 mmHg with wide 95% limits of agreement (-4.7 to 10.3 mmHg), exceeding the clinically acceptable threshold. Oxygenation impairment (PaO₂/FiO₂ < 200 mmHg) significantly reduced the proportion of clinically acceptable measurements (55.9% vs. 81.7%, P = 0.0001). In multivariable analysis, EtCO₂-PaCO₂ disagreement occurred exclusively in infants ventilated under the non-protective protocol (VT 8 mL/kg with ZEEP). After excluding ventilatory variables that were structurally confounded with randomized allocation, lower lung compliance was independently associated with disagreement (adjusted OR 1.66, 95% CI 1.05-2.64, P = 0.030).
conclusionsEtCO₂ provides only limited reliability as a stand-alone substitute for arterial blood gas analysis in infants during OLV, particularly under non-protective ventilation. The lung-protective ventilation strategy as a composite intervention is associated with substantially improved EtCO₂-PaCO₂ agreement during OLV in infants. Among individual patient-level factors, lower lung compliance independently predicts EtCO₂-PaCO₂ disagreement and may serve as a bedside indicator for clinicians to consider supplementary arterial blood gas analysis.
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