Positive Pressure Respiratory Support Research Articles

Changes in the intestinal microbiome of the preterm baby associated with stopping non-invasive pressure support: a prospective cohort study

BackgroundIntestinal dysbiosis is implicated in the pathogenesis of necrotising enterocolitis and late-onset sepsis in preterm babies. The provision of non-invasive positive pressure ventilation is a common clinical intervention in preterm...

Preterm Infants off Positive Pressure Respiratory Support Have a Higher Incidence of Occult Cerebral Hypoxia

To use cerebral near-infrared spectroscopy (NIRS) to quantify occult cerebral hypoxia across respiratory support modes in preterm infants. In this prospective, longitudinal, observational study, infants ≤32weeks gestation underwent serial pulse oximetry (oxygen saturation [SpO2]) and cerebral NIRS monitoring (4-6hours per session) following a standardized recording schedule (daily for 2 weeks, every other day for 2 weeks, then weekly until 35weeks corrected gestational age). Four calculations were made: median cerebral saturation, median cerebral hypoxia burden (proportion of NIRS samples below the hypoxia threshold [<67%]), median systemic saturation, and median systemic hypoxia burden (proportion of SpO2 samples below the desaturation threshold [<85%]). During each recording session, respiratory support mode was noted (room air, low-flow nasal cannula, high-flow nasal cannula, noninvasive positive pressure ventilation, continuous positive airway pressure, and invasive ventilation). There were 1013 recording sessions made from 174 infants with a median length of 6.9hours. Although the systemic (SpO2) hypoxia burden was significantly greater for infants on the highest respiratory support (invasive and noninvasive positive pressure ventilation), the cerebral hypoxia burden was significantly greater during recording sessions made on the lowest respiratory support (8% for room air; 29% for low-flow nasal cannula). Premature infants on the highest levels of respiratory support have less cerebral hypoxia than those on lower respiratory support. These results raise concern about unrecognized cerebral hypoxia during lower acuity periods of neonatal intensive care unit hospitalization and adverse outcomes.

Pulmonary hypertension in preterm infants with moderate-to-severe bronchopulmonary dysplasia (BPD).

To describe clinical characteristics of pulmonary hypertension (PH) associated with moderate to severe BPD (MSBPD) in premature infants born ≤32 weeks gestation. This was a single centre retrospective cohort study, with reanalysis of echocardiographic studies for PH of infants born ≤32 weeks gestation with MSBPD admitted to a tertiary surgical neonatal service. In total, 268 babies with MSBPD were included in the study. Incidence of BPD-associated PH (BPD-PH) was 12.6% (34), of which 41% infants were observed to have severe PH. On multivariate analysis, need for positive pressure respiratory support at 36 weeks post menstrual age (PMA) was independently associated with PH (p = 0.001; 95% CI 2-13.5) Presence of PH and severity of PH were associated with increased mortality. Of babies with MSBPD-PH, 32% died before discharge from the neonatal unit. Babies with MSBPD and PH are more likely to die before discharge from the neonatal unit. Need for positive pressure respiratory support at 36 weeks PMA is independently associated with PH. Babies with MSBPD with less than severe PH are also associated with increased mortality when compared to babies with MSBPD with no PH.

The safety of respiratory positive pressure support immediately following pediatric tonsillectomy.

Adenotonsillectomy is the first-line treatment for pediatric obstructive sleep apnea (OSA). The postoperative course may be complicated by hypoxia, requiring intervention. Positive pressure respiratory support (PPS) could be used to bridge the postoperative period and avoid invasive mechanical ventilation; however, the safety of PPS following tonsillectomy has not been established. Objective To review the incidence of complications and risk factors associated with PPS use immediately after tonsillectomy. A retrospective cohort study between 2015 and 2020 of patients who underwent tonsillectomy and were admitted to the pediatric intensive care unit at a single healthcare system. Seven hundred eighty patients met inclusion criteria, including 101 patients treated with PPS immediately following surgery. A similar number of patients were diagnosed with severe OSA in each group prior to surgery. One patient in the PPS cohort developed pneumomediastinum and pneumothorax. Eleven patients (12%) in the PPS group and 18 patients (2%) in the non-PPS group developed life-threatening complications, defined as pneumothorax/pneumomediastinum, re-intubation, post-tonsillectomy bleeding that required surgical intervention, pulmonary edema and death, and all occurred in patients who had not used PPS at baseline. Regression analysis identified body mass index, surgical technique, and PPS use to be associated with increased odds of life-threatening complications. Our study suggests that PPS is generally safe to use. New-onset PPS is associated with increased odds of life-threatening complications, likely reflecting a severe post-surgical clinical course.

Urine Desmosine as a Novel Biomarker for Bronchopulmonary Dysplasia and Postprematurity Respiratory Disease in Extremely Preterm or Low Birth Weight Infants.

This study aimed to evaluate whether elevated urine desmosine levels at 3 weeks of age were associated with severe radiological findings, bronchopulmonary dysplasia (BPD), and post-prematurity respiratory disease (PRD) in extremely preterm (EP) or extremely low birth weight (ELBW) infants. This study recruited 37 EP (22-27 completed weeks) or ELBW (<1,000 g) infants. Urine was collected between 21 and 28 postnatal days, and desmosine was measured using an enzyme-linked immunosorbent assay kit; the urine creatinine level was also measured. Bubbly/cystic lungs were characterized by emphysematous chest X-rays on postnatal day 28. Furthermore, provision of supplemental oxygen or positive-pressure respiratory support at 40 weeks' postmenstrual age defined BPD, and increased medical utilization at 18 months of corrected age defined PRD. The desmosine/creatinine threshold was determined by receiver operating characteristic analysis. The adjusted risk and 95% confidence interval (CI) for elevated urine desmosine/creatinine levels were estimated by logistic regression analysis. Elevated urine desmosine/creatinine levels higher than the threshold were significantly associated with bubbly/cystic lungs (8/13 [61.5%] vs. 2/24 [8.3%], p = 0.001), BPD (10/13 [76.9%] vs. 8/24 [33.3%], p = 0.02), and PRD (6/13 [46.2%] vs. 2/24 [8.3%], p = 0.01). After adjusting for gestational age, birth weight, and sex, the urine desmosine/creatinine levels were significantly higher in those who were highly at risk of bubbly/cystic lungs (odds ratio [OR], 13.2; 95% CI, 1.67-105) and PRD (OR, 13.8; 95% CI, 1.31-144). Elevated urine desmosine/creatinine levels on the third postnatal week were associated with bubbly/cystic lungs on day 28 and PRD at 18 months of corrected age in EP or ELBW infants. · Urine desmosine was prospectively measured in 3-week-old EP/ELBW infants.. · Elevated urine desmosine levels were associated with emphysematous radiological findings on day 28, PRD at 18 months of corrected age.. · Urine desmosine may be a promising biomarker indicating lung damage in EP/ELBW infants..

899: COMPARISON OF CORTICOSTEROID DOSING IN NONINVASIVE POSITIVE PRESSURE VENTILATION COVID-19 PATIENTS

Introduction: High dose corticosteroids decrease ventilator free days in mechanically ventilated COVID-19 patients, however there is limited data on the benefit of higher doses in patients receiving non-invasive positive pressure ventilation. The purpose of this study was to compare high versus low dose corticosteroids’ impact on ventilator free days for COVID-19 patients who received continuous non-invasive positive pressure respiratory support. Methods: This retrospective study included COVID-19 positive patients diagnosed within 14 days of hospital admission, aged 18 years or older, and those who received at least 48 hours of corticosteroids while on continuous non-invasive positive pressure ventilation. Patients were excluded if they were pregnant, had active malignancy, transferred from an on outside facility, used oral corticosteroids within 10 days of hospitalization, and those who died or had comfort care orders placed within 24 hours of admission. The primary objective of this study compared ventilator free days between high dose (dexamethasone 20 mg or methylprednisolone ≥ 120 mg per day) and low dose (dexamethasone 6 mg per day) corticosteroids for patients who received continuous non-invasive positive pressure ventilation. Secondary objectives compared mortality, intensive care unit (ICU) length of stay, and hyperglycemia rates between groups. Results: A total of 72 patients were included in this study with 36 patients in each group. There was a statistically significant difference of 3 ventilator free days between the high and low dose corticosteroid groups (median [IQR], 12 days [8-16] vs 9 days [7-12], p=0.047). No difference was found between groups for ICU length of stay or inpatient mortality. There was an increased incidence of hyperglycemia in the high dose group compared to the low dose group (n [%], 32 patients [89] vs 24 patients [67], p=0.023). Conclusions: Initiating high dose corticosteroids for COVID-19 patients on non-invasive positive pressure ventilation is associated with an increase in ventilator-free days. The use of high dose corticosteroids in this patient population could help to delay or prevent intubation and the complications associated with mechanical ventilation. Future studies should evaluate duration of therapy and additional therapies for COVID-19 patients.

Transpyloric Feeding is Associated With Improved Oxygenation Compared With Gastric Feeding Among Nonintubated Extremely Low Birth Weight Infants

To study the impact of transpyloric (TP) feed initiation on short-term oxygenation and manual oxygen blender titration among extremely low birth weight infants. This retrospective study evaluated several measures of oxygenation among extremely low birth weight infants receiving positive pressure respiratory support for 96hours before and after TP tube placement in a single neonatal intensive care unit during the years 2017- 2020. The measures included the achieved oxygen saturation (SpO2), the baseline fraction of inspired oxygen (FiO2), the SpO2/FiO2 ratio, the number and severity of hypoxemic episodes and the frequency of manual oxygen titrations (titration index) and were analyzed using an interrupted time series regression approach. A total of 56 infants were evaluated. No significant differences were observed in any oxygenation measures during TP vs gastric feeding among 14 intubated infants. However, among 42 nonintubated patients, significant improvements were observed in the median SpO2/FiO2 ratios (P=.001), median titration index (P=.05), median number of hypoxemic episodes (P=.02), and median severity of hypoxemic episodes (P=.008) after TP tube placement. The transition from gastric to TP tube feeding was temporally associated with acute improvement in oxygenation for nonintubated infants, but not for intubated infants.

Echocardiographic Markers of Mild Pulmonary Hypertension are not Correlated with Worse Respiratory Outcomes in Infants with Bronchiolitis.

Pulmonary hypertension has been reported as a crucial factor in the pathophysiology of severe bronchiolitis. The aim of this study was to evaluate pulmonary artery pressure (PAP) in patients with bronchiolitis and to analyze their correlation with clinical outcomes. This prospective cohort study examined children admitted for bronchiolitis. PAP was assessed by right ventricle (RV) acceleration/ejection time ratio (AT/ET), isovolumic relaxation time, eccentricity index, and the presence of a pulmonary systolic notch. Pulmonary hypertension (PH) was considered if at least two altered parameters were present. Severity of clinical course was established by higher N-terminal (NT)-prohormone BNP (NT-proBNP) values, the need for positive pressure respiratory support (PPRS), and the duration of hospital admission. One hundred sixty-nine children were included in analysis. Sixty-eight patients (40%) required PPRS, and those patients had increased NT-proBNP values and worse tricuspid annular systolic excursion (TAPSE) compared to mild cases (p < 0.001and p < 0.001, respectively). Twenty-two (13%) cases had at least two altered parameters of PAP and met criteria for presumed PH, with no differences in NT-proBNP values, TAPSE, need for PPRS or hospital length of stay compared to normal PAP group (p = 0.98, p = 0.07, p = 0.94 and p = 0.64, respectively). We found no correlation between altered RV AT/ET and worse cardiac function, NT-proBNP values or hospital length of stay. In our cohort, the presence of echocardiographic findings of PH were not associated with worse clinical outcomes. Patients with severe bronchiolitis had higher values ​​of NT-proBNP but, interestingly, no clear association with PH.

Cardiac function in bronchiolitis: Not only a right ventricle matter.

Extrapulmonary manifestations of bronchiolitis have been previously studied, with some identifying right ventricle (RV) diastolic/systolic dysfunction. We hypothesized that severe cases of bronchiolitis would have cardiac dysfunction resulting an increase in N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) values and worse outcomes. Therefore, the objective was to evaluate the existence of cardiac dysfunction and to determine its association with severe bronchiolitis. This prospective cohort study included children hospitalized for bronchiolitis under 1-yearold between January 2019 and March 2020. At admission, an echocardiography was performed and plasma levels of NT-proBNP were measured. To analyze outcomes, the cohort was divided into two groups based on the need for positive pressure respiratory support (PPRS), and both were compared to healthy infants. bivariant analysis, significant differences p < 0.05. One hundred eighty-one patients were included; median age was 2 months. Seventy-three patients required PPRS. Compared to controls, patients requiring PPRS showed worse RV systolic function, with lower tricuspid annular-plane systolic excursion (p = 0.002) and parameters of worse right and left diastolic function (trans-tricuspid E and A wave [p = 0.004 and p = 0.04, respectively] and tricuspid tissue doppler imaging [TDI] e' [p = 0.003], trans-mitral E and mitral TDI a' [p = 0.02 and p = 0.005, respectively]). AnNT-ProBNP greater than 3582 pg/dl predicts the need for longer necessity of PPRS in patients younger than 2 months. In addition to the expected RV systolic dysfunction, patients with severe bronchiolitis have parameters of global diastolic worse function possibly secondary to intrinsic myocardial involvement. NT-ProBNP values at admission had strong discriminatory power to predict worse outcomes.

A successful interdisciplinary collaboration for the management of pneumoperitoneum and pericardial effusion in a premature newborn

Objectives. Percutaneously central catheters are typically used in neonatal intensive care units (NICU) to provide parenteral nutrition and drug therapy administration. Their use is associated with specific complications: occlusions, infections, thrombosis, rupture, and migration, including rare life-threatening conditions such as pericardial effusion and cardiac tamponade. Material and methods. We present the case of a patient hospitalized in the Neonatology Department of “Sf. Andrei” County Clinical Emergency Hospital of Constanta, diagnosed with cardiac tamponade at 18 days of life. Outcomes. Premature male newborn, gestational age (GA) of 33 weeks, birth weight (BW) 2380 g, Apgar score 5/7, issuing from pregnancy without prenatal care, admitted in NICU with Continuous Positive Airway Pressure (CPAP) respiratory support. He required intensive care during the neonatal period and presented with sudden cardiac instability 18 days after the insertion of a peripherally inserted central catheter (PIC-Line). The echocardiography demonstrated severe pericardial effusion with evidence of cardiac tamponade. Successful urgent subxiphoid pericardiocentesis was performed. Totally 20 ml of fluid was collected, consistent with the composition of the hyperosmolar solution infused. Conclusions. Despite the fact that it is a rare complication, cardiac tamponade should be considered in any newborn with a PIC-Line who presents with sudden suggestive deterioration (cardiorespiratory instability, bradycardia, cyanosis and metabolic acidosis), which does not respond to resuscitation maneuvers, when lines are considered to be placed correctly. Implementing a modern algorithm, who is easy to learn and quick to perform, with the help of ultrasonography, represents the key of success for detecting urgent neonatal complications leading to sudden deterioration.

Recent advances in paediatric sleep disordered breathing.

To understand the clinical impact of childhood sleep disordered breathing (SDB).To understand that, while sleep laboratory polysomnography has been the gold standard for diagnosis of SDB, other diagnostic techniques exist with their own benefits and limitations.To recognise that adenotonsillectomy and positive pressure respiratory support are the mainstays of treating childhood SDB, but different approaches may be indicated in certain patient groups.

Associations Between Weight and Lower Respiratory Tract Disease Outcomes in Hospitalized Children.

To identify associations between weight status and clinical outcomes in children with lower respiratory tract infection (LRTI) or asthma requiring hospitalization. We performed a retrospective cohort study of 2 to 17 year old children hospitalized for LRTI and/or asthma from 2009 to 2019 using electronic health record data from the PEDSnet clinical research network. Children <2 years, those with medical complexity, and those without a calculable BMI were excluded. Children were classified as having underweight, normal weight, overweight, or class 1, 2, or 3 obesity based on Body Mass Index percentile for age and sex. Primary outcomes were need for positive pressure respiratory support and ICU admission. Subgroup analyses were performed for children with a primary diagnosis of asthma. Outcomes were modeled with mixed-effects multivariable logistic regression incorporating age, sex, and payer as fixed effects. We identified 65 132 hospitalizations; 6.7% with underweight, 57.8% normal weight, 14.6% overweight, 13.2% class 1 obesity, 5.0% class 2 obesity, and 2.8% class 3 obesity. Overweight and obesity were associated with positive pressure respiratory support (class 3 obesity versus normal weight odds ratio [OR] 1.62 [1.38-1.89]) and ICU admission (class 3 obesity versus normal weight OR 1.26 [1.12-1.42]), with significant associations for all categories of overweight and obesity. Underweight was also associated with positive pressure respiratory support (OR 1.39 [1.24-1.56]) and ICU admission (1.40 [1.30-1.52]). Both underweight and overweight or obesity are associated with increased severity of LRTI or asthma in hospitalized children.

Early surfactant and non-invasive ventilation versus intubation and surfactant: a propensity score-matched national study

ObjectiveTo compare outcome after less invasive surfactant administration (LISA) and primary endotracheal intubation (non-LISA) in infants born before gestational age (GA) 28 weeks.SettingAll neonatal intensive care units (NICUs) in Norway...

Short-term outcomes of very low-birthweight infants with intraventricular haemorrhage who received respiratory support in a middle-income country neonatal unit

Background. Prematurity is a major risk factor for intraventricular haemorrhage (IVH). Premature infants often require respiratory support. There is little information on neonates with IVH on respiratory support in low- and middle-income countries. Objective. To describe the characteristics and short-term outcomes of very-low-birthweight (VLBW) infants with IVH receiving respiratory support in a tertiary neonatal unit with resource limitations. Methods. This was a matched retrospective observational study. The population included VLBW infants with IVH, who received positive pressure respiratory support between January 2014 and December 2016. Severe IVH was compared with mild IVH. Results. One hundred and fifty infants were included in the study; 56 (37%) received continuous positive airway pressure (CPAP) only and 94 (63%) mechanical ventilation. Severe IVH was associated with surfactant therapy across both ventilation groups ( p =0.03). Infants with severe IVH had prolonged oxygen requirements at 28 days (79% v. 38%; p =0.01) (odds ratio (OR) 6.11; 95% confidence interval (CI) 1.19 - 31.34; p =0.03) v. those with mild IVH. Severe IVH and the presence of coagulopathy were the strongest predictors of death in both ventilation groups ( p <0.0001). Pulmonary haemorrhage was the most common cause of death in severe IVH and blood culture-confirmed sepsis in mild IVH. Periventricular leukomalacia (PVL) was associated with severe IVH in invasive ventilation (OR 6.67; 95% CI 1.11 - 40.17). Conclusion. VLBW infants with severe IVH who are mechanically ventilated or with coagulopathy have a high mortality, with pulmonary haemorrhage being the prominent cause of death. These prognostic factors may assist in end-of-life care in resource-limited settings.

A comparison of methods of discontinuing nasal CPAP in premature infants

ObjectiveThe objective of this study was to determine whether abrupt discontinuation vs gradual wean of nasal CPAP (NCPAP) in infants <30 weeks gestation results in a decreased duration of NCPAP therapy.Study designWe performed a single-center, randomized control trial of premature infants born <30 weeks gestation (n = 66), comparing discontinuation of NCPAP from 6 cmH2O (CWP) (fast wean arm) to discontinuation at 4 CWP, weaning by 1 CWP per day (slow wean arm). The primary outcome was the total number of days on NCPAP or mechanical ventilation. Secondary outcomes included wean failure, growth, length of stay, and related comorbidities.ResultsDuration of NCPAP or mechanical ventilation was longer in the slow wean arm compared to the fast wean arm (17 vs 12 days, p = 0.03). There were no differences observed in secondary outcomes.ConclusionIn weaning NCPAP, abrupt discontinuation may be associated with a shorter duration of positive pressure respiratory support compared to a gradual weaning strategy.

Life-threatening bronchopulmonary dysplasia: a British Paediatric Surveillance Unit Study

ObjectivesTo assess the minimum incidence of life-threatening bronchopulmonary dysplasia (BPD), defined as need for positive pressure respiratory support or pulmonary vasodilators at 38 weeks corrected gestational age (CGA), in infants...

Ultrasound measurements of abdominal muscle thickness are associated with postmenstrual age at full oral feedings in preterm infants: A preliminary study.

A premature infant's discharge from the neonatal intensive care unit (NICU) is dependent on factors such as respiratory stability, adequate growth, and the ability to consume oral feeds. Once infants have achieved respiratory stability, a tool that can better predict age at discharge is desirable. Thus, we conducted a secondary data analysis to assess the association between ultrasound measurements of abdominal muscle thickness and postmenstrual age (PMA) at full oral feedings. Forty-nine (n = 49) healthy, premature infants (mean gestational age = 32 weeks) were recruited from the NICU. Anthropometric measurements and ultrasound measurements of the rectus abdominis were conducted when infants were medically stable. Fat-free mass (FFM) was obtained using air displacement plethysmography. The relationship between ultrasound measurements of muscle thickness and PMA at full oral feedings was assessed using linear regression analysis. The relationship between FFM z-scores and PMA at full oral feedings was also assessed for comparison. When adjusting for gestational age at birth, PMA at measurement, days of positive pressure respiratory support, weight, and length, ultrasound measurements of abdominal muscle thickness were independently, negatively associated with PMA at full oral feedings (β estimate: -0.71, P = .03). Preliminary results suggest infants with greater abdominal muscle thickness may reach full oral feedings at an earlier PMA (nearly 1 week per millimeter). Thus, ultrasound measurements of abdominal muscle thickness may be helpful in assessing readiness for discharge in healthy preterm infants. Further research is needed for development and validation of a prediction equation.

In-hospital outcomes of late referrals for established bronchopulmonary dysplasia.

To determine the in-hospital outcomes for patients with established bronchopulmonary dysplasia (BPD) referred late for severe disease. Retrospective cohort study of patients with established BPD referred to our center after 36 weeks PMA. Among 71 patients with BPD referred to our center after 36 weeks PMA between 2010 and 2018, the median PMA was 47 weeks (IQR, 42, 53) and the median respiratory severity score was 8.1 (IQR 4.5, 11.0) on admission. Survival in this cohort was 92%. Most survivors were discharged home without the need for positive pressure respiratory support (77%) or pulmonary vasodilators (89%). For survivors, we observed a significant improvement in median z-scores for length (-6.7 vs -3.3, p < 0.0001) between admission and discharge. Despite presenting relatively late with a high degree of illness severity, nearly all patients in this cohort survived to hospital discharge with improvement in comorbidities.

Oral feeding for infants and children receiving nasal continuous positive airway pressure and high flow nasal cannula: a systematic review

BackgroundThe aim of this systematic review was to determine whether introduction of oral feeding for infants and children receiving nasal continuous positive airway pressure (nCPAP) or high flow nasal cannula (HFNC) respiratory support facilitates achievement of full oral feeding without adverse effects, compared to no oral feeding (NPO; nil per oral) on CPAP or HFNC.MethodsA protocol was lodged with the PROSPERO International Prospective Register of Systematic Reviews. We searched Medline, Embase, CINAHL, CENTRAL and AustHealth from database inception to 10th June 2020. Study population included children (preterm to < 18 years) on nCPAP or HFNC who were orally feeding. Primary outcomes included full or partial oral feeding and oropharyngeal aspiration. Secondary outcomes examined adverse events including clinical signs of aspiration, aspiration pneumonia and deterioration in respiratory status.ResultsThe search retrieved 1684 studies following duplicate removal. Title and abstract screening identified 70 studies for full text screening and of these, 16 were included in the review for data extraction. Methods of non-invasive ventilation (NIV) included nCPAP (n = 6), nCPAP and HFNC (n = 5) and HFNC (n = 5). A metanalysis was not possible as respiratory modes and cohorts were not comparable. Eleven studies reported on adverse events. Oral feeding safety was predominantly based on retrospective data from chart entries and clinical signs, with only one study using an instrumental swallow evaluation (VFSS) to determine aspiration status.ConclusionsFindings are insufficient to conclude whether commencing oral feeding whilst on nCPAP or HFNC facilitates transition to full oral feeding without adverse effects, including oropharyngeal aspiration. Further research is required to determine the safety and efficacy of oral feeding on CPAP and HFNC for infants and children.Trial registrationPROSPERO registration number: CRD42016039325.

Nocturnal Transcutaneous Blood Gas Measurements in a Pediatric Neurologic Population: A Quality Assessment

ABSTRACT Objective: To assess the quality of SpO2 and PCO2 recordings via transcutaneous monitoring in children with neurological conditions. Methods: Overnight transcutaneous SpO2 and PCO2 were analyzed. The presence of drift and drift correction was noted, and the rate of disrupted recordings scored (0: absence, 1; presence). The quality of recordings was also scored (0, 1, 2 for poor, medium, and high). Results: A total of 228 recordings from 64 children aged 9.7 ± 6 years were analyzed of which 42 used positive pressure respiratory support. The mean quality of the recordings was scored as 1.27 (0–2). PCO2 drift, drift correction, and disrupted recordings were present in 25%, 58%, and 26% of recordings, respectively. Satisfactory clinical decisions were taken in 91% of cases. Conclusion: The quality of transcutaneous sensor recordings was acceptable and clinical findings were deemed as satisfactory in the large majority of cases. Correction of PCO2 drift was challenging.