Noninvasive capnometry for end-tidal carbon dioxide monitoring via nasal cannula in nonintubated neonates (original) (raw)
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Pediatric Pulmonology, 2003
End-tidal carbon dioxide pressure (PetCO(2)) was measured in the neonatal intensive care unit (NICU) to assess its reliability and accuracy in predicting arterial partial pressure of carbon dioxide (PaCO(2)). Arterial blood was drawn for gas analysis and compared with exhaled CO(2) measured by mainstream capnography. In total, 130 PetCO(2)/PaCO(2) comparisons were obtained from 61 patients (20 term and 41 preterm infants). PetCO(2) was significantly different from PaCO(2) (PetCO(2) = 42.3 +/- 10.5 mmHg vs. PaCO(2) = 45.8 +/- 12.3 mmHg, P < 0.001, mean +/- SD). The overall PetCO(2) bias (mean +/- SD) was 3.5 +/- 7.1 mmHg. There was a positive correlation between PetCO(2) and PaCO(2) (n = 130, r = 0.818, P < 0.001) in both term (n = 44, r = 0.779, P < 0.001) and preterm infants (n = 86, r = 0.849, P < 0.001). The PetCO(2) biases (95% CI) were 3.5 +/- 9.0 mmHg (0.8-6.2) in the term group and 3.4 +/- 6.0 mmHg (2.2-4.7) in the preterm group. Therefore, PetCO(2) was a valid and reliable method for monitoring PaCO(2) in neonates, especially preterm infants. This method decreases blood loss and prevents complications associated with arterial catheters. In conclusion, we recommend using mainstream capnography to monitor PetCO(2) instead of measuring PaCO(2) in the NICU.
1990
To determine whether end-tidal PC02 (PE?~02) measurements obtained with two infrared capnometers accurately" approximates the arterial PC02 (PaCO2) in critically ill neonates, simultaneous measurements of PETC02 were obtained from the distal and proximal ends of the tracheal tube with a sidestream capnometer (Puritan Bennett/Datex-BP/D) and from the proximal end with a mainstream capnometer (Hewlett-Packard-liP) in 20 intubated neonates. Distal sidestream PeTC02 and mainstream PETC02 correlated with the PaC02 (r 2 = 0.66 and 0.61, respectively) within the range of 26-57 mmHg PaC02. However, proximal PETC02 with the sidestream capnometer correlated very poorly (t 2 = 0.09) with PaC02. The slope of the least square regression line for the distal sidestream capnometer, 0.67, was significantly less than that for the mainstream capnometer, O. 78 but both were significantly greater than that for the proximal sidestream capnometer, 0.39 (P < 0.05). The slope of the regression for the proximal sidestream capnometer did not differ significantly from horizontal. Insertion of the mainstream sensor for the HP capnometer significantly increased the transcutaneous C02 when compared with preinsertion values. We conclude that both distal sidestream and mainstream capnometry provide accurate estimates of the PaC02 in critically ill neonates.
Intensive Care Medicine, 2009
Background Monitoring CO2 levels in preterm infants receiving mechanical ventilation is designed to avoid the harmful consequences of hypocapnia or hypercapnia. Capnography is of questionable accuracy for monitoring PCO2 in preterm infants. Objectives To determine the accuracy of sidestream capnography in ventilated preterm infants by comparing end-tidal carbon dioxide (EtCO2) values to mixed venous carbon dioxide pressure (PvCO2) and to transcutaneous carbon dioxide pressure (TcPCO2). Methods Simultaneous recordings of EtCO2, TcPCO2 and PvCO2 in 37 ventilated preterm infants. The PvCO2–EtCO2 gradient was calculated. The Bland–Altman technique and the intra-class correlation coefficient (ICC) were used to assess agreement between methods. The area under the curve (AUC) was calculated. Results Ninety-nine EtCO2/PvCO2 pairs were studied from 37 preterm infants with a mean gestational age of 27.7 ± 1.9 weeks and a mean birth weight of 1,003 ± 331 g. The mean PvCO2–EtCO2 gradient was 11.2 ± 8.0 mmHg, and the ICC was 0.28. The mean PvCO2–TcPCO2 gradient was 0 ± 7.8 mmHg, and the ICC was 0.78. AUCs for EtCO2 and TcPCO2 were similar in detecting high or low PvCO2. Conclusion Despite an insufficient correlation between EtCO2 and PvCO2, capnography was able to detect low and high CO2 warning levels with a similar efficacy to that of TcPCO2, and may therefore be of clinical interest.
Pediatric Pulmonology, 2015
Background and Objective: High-frequency ventilation (HFV) is a powerful tool for CO 2 elimination, and thus requires careful monitoring of CO 2. Our aim was to assess the diagnostic accuracy (correlation, agreement, and trending) of continuous distal capnography (dCap) with PaCO 2 in infants ventilated with HFV. Design: This was a prospective, observational, multicenter study. dCap was compared with simultaneous PaCO 2 ("gold standard") drawn from indwelling arterial line for patient care in term and preterm infants ventilated with HFV. dCap was obtained via the side-port of a double-lumen endotracheal-tube by a Microstream capnograph with specially designed software for HFV. Results: Twenty-four infants participated in the study (median [range] gestational age [GA]: 26.8 [23.6-38.6] weeks). Analysis included 332 measurements. dCap was in correlation (r ¼ 0.70, P < 0.001) but with less than adequate agreement (mean difference AE SD of the differences: À11.7 AE 10.3 mmHg) with PaCO 2. Comparable findings were found in the subgroup of infants <1,000 g (n ¼ 240 measurements). Correlations were maintained in severe lung disease. Changes in dCap and in PaCO 2 for consecutive measurements within each patient were correlated (r ¼ 0.63, P < 0.001). Area under the receiver operating curves (ROC) for dCap to detect high (>60 mmHg) or low (<30 mmHg) PaCO 2 was 0.83 (CI: 0.76-0.90) and 0.88 (CI: 0.79-0.97), respectively; P < 0.001. Conclusions: Our prospective study suggests that continuous dCap in infants ventilated with HFV may be helpful for trends and alarm for unsafe levels of PaCO 2. dCap is only a complimentary tool and cannot replace PaCO 2 sampling because the agreement between these measurements was less than adequate.
Correlation of end tidal and arterial carbon dioxide levels in critically Ill neonates and children
2014
Aim of the Study: End tidal carbon dioxide (EtCO 2) monitoring is considered to refl ect real-time estimation of partial pressure of carbon dioxide in arterial blood (PaCO 2) noninvasively. However, knowledge about its relationship with PaCO 2 in critically ill pediatric and neonatal patients is limited. The primary objective was to evaluate predictive capability of end tidal carbon dioxide monitoring and secondary objective was to determine the infl uence of severity of lung disease on EtCO 2 and PaCO 2 relationship. Materials and Methods: This was a prospective, nonrandomized, consecutive enrollment study carried out in neonatal and pediatric intensive care units of a tertiary care children hospital. It was conducted in 66 neonates and 35 children receiving mechanical ventilation. Severity of lung disease was estimated by ventilation index and PaO 2 /FiO 2 (P/F) ratio. Simultaneous recording of EtCO 2 and PaCO 2 levels was done and data were analyzed for correlation and agreement. Results: In neonates, 150 EtCO 2 and PaCO 2 pairs were recorded. The mean weight ± SD of patients was 2.1 ± 0.63 kg. PaCO 2 had a positive correlation with EtCO 2 (r = 0.836, 95% CI = 0.78-0.88). P/F ratio <200 adversely affected relationship. In infants and children, 96 pairs were recorded. Mean age ± SD of patients was 4.20 ± 4.92 years and mean weight ± SD was 13.1 ± 9.49 kg. PaCO 2 had an excellent correlation with EtCO 2 (r = 0.914, 95% CI = 0.87 and 0.94). P/F ratio <200 adversely affected relationship. Conclusion: EtCO 2 monitoring displayed a good validity to predict PaCO 2. Correlation was affected by low P/F ratio (<200); hence, it is recommended that blood gases be measured in these patients until such time that a good relation can be established between end tidal and arterial CO 2 values.
PEDIATRICS, 2008
OBJECTIVE. The objective of this study was to evaluate a novel method of distal end-tidal CO2 capnography by comparison with Paco2 and with the more standard method that measures mainstream proximal end-tidal CO2 in intubated infants. METHODS. Included in the study were all infants who were ventilated with conventional mechanical ventilation and intubated with a double-lumen endotracheal tube in our NICU during the study period. Data were collected prospectively from 2 capnographs simultaneously and compared with Paco2. Sidestream distal end-tidal CO2 was measured by a Microstream capnograph via the extra port of a double-lumen endotracheal tube. Mainstream proximal end-tidal CO2 was measured via capnograph connected to the endotracheal tube. RESULTS. Twenty-seven infants (median [range] birth-weight: 1835 [490–4790] g; gestational age: 32.5 [24.8–40.8] weeks) participated in the study. We used for analysis 222 and 212 measurements of distal end-tidal CO2 and proximal end-tidal CO2,...
Pediatric Pulmonology, 2012
Objective: We aimed to determine the correlation and the agreement between endtidal carbon dioxide (ETCO 2 ) and partial pressure of arterial carbon dioxide (PaCO 2 ) in very low birth weight infants (VLBWI); furthermore, we assessed factors that could affect the ETCO 2 -PaCO 2 relationship. Methods: Simultaneous end-tidal and arterial CO 2 pairs were obtained from ventilated VLBWI who were monitored by mainstream capnography and had umbilical arterial catheter. Correlation and agreement between ETCO 2 and PaCO 2 were evaluated by using Spearman test and Bland-Altman method, respectively. Results: A total of 143 simultaneous ETCO 2 -PaCO 2 pairs were analyzed from 45 ventilated VLBWI. There was a significant correlation (r ¼ 0.69; P < 0.0001) between ETCO 2 and PaCO 2 values. The ETCO 2 value was lower than the corresponding PaCO 2 value in 94% pairs, with a mean bias of 13.5 AE 8.4 mmHg (95% agreement levels, À3.0 to 29.9 mmHg). Mean PaCO 2 -ETCO 2 bias was similar between ELBWI (13.1 AE 7.7 mmHg; 95% agreement levels, À1.9 and 28.2 mmHg) and infants with birth weight 1,001-1,500 g (14.8 AE 9.7 mmHg; 95% agreement levels À4.3 and 33.8 mmHg). The bias between ETCO 2 and PaCO 2 was significantly increased with increasing FiO 2 , mean airway pressure and oxygenation index. Within each patient, there was a positive correlation (r ¼ 0.78, P < 0.0001) between the changes in PaCO 2 and the simultaneous changes in ETCO 2 . Conclusions: In ventilated VLBWI, the correlation between mainstream ETCO 2 and PaCO 2 is good, but the agreement is poor and negatively influenced by the severity of pulmonary disease. Capnography is feasible in ELBWI. ETCO 2 should not replace PaCO 2 measurements in ventilated VLBWI, but may have a role to detect trends of PaCO 2 .
Impact of Continuous Capnography in Ventilated Neonates: A Randomized, Multicenter Study
The Journal of pediatrics, 2015
To compare the time spent within a predefined safe range of CO2 (30-60 mmHg) during conventional ventilation between infants who were monitored with distal end-tidal CO2 (dETCO2, or capnography) and those who were not. For this randomized, controlled multicenter study, ventilated infants with a double-lumen endotracheal tube were randomized to 1 of 2 groups: the open (monitored) group, in which data from the capnograph were recorded, displayed to the medical team, and used for patient care, and the masked group, in which data from the capnograph were recorded. However, the measurements were masked and not available for patient care. dETCO2 was compared with PaCO2 measurements recorded for patient care. Fifty-five infants (25 open, 30 masked) participated in the study (median gestational age, 28.6 weeks; range, 23.5-39.0 weeks). The 2 groups were comparable. dETCO2 was in good correlation (r = 0.73; P < .001) and adequate agreement (mean ± SD of the difference, 3.0 ± 8.5 mmHg) wit...
Iranian Journal of Pediatrics, 2015
Background: Noninvasive transcutaneous carbon dioxide monitoring has been shown to be accurate in infants and children, limited data are available to show the usefulness and limitations of partial transcutaneous carbon dioxide tension (PtCO 2) value. Objectives: The current study prospectively determines the effectiveness and accuracy of PtCO 2 measurements in newborns. Materials and Methods: Venous blood gas sampling and monitoring of the PtCO 2 level (TCM TOSCA, Radiometer) were done simultaneously. All measurements are performed on mechanically ventilated infants. Partial venous carbon dioxide tension (PvCO 2) values divided into three groups according to hypocapnia (Group 1: < 4.68 kPa), normocapnia (Group 2: 4.68-7.33 kPa), hypercapnia (Group 3: > 7.33 kPa) and then PvCO 2 and PtCO 2 data within each group were compared separately. Results: A total of 168 measurements of each PvCO 2 and PtCO 2 data were compared in three separated groups simultaneously (13 in Group 1, 118 in Group 2, and 37 in Group 3). A bias of more than ± 0.7 kPa was considered unacceptable. PtCO 2 was related to PvCO 2 with acceptable results between the two measurements in hypocapnia (mean difference 0.20 ± 0.19 kPa) and normocapnia (0.002 ± 0.30 kPa) groups. On the other hand in hypercapnia group PtCO 2 values were statistically significant (P < 0.001) and lower than PvCO 2 data (mean difference 0.81 ± 1.19 kPa) Conclusions: PtCO 2 measurements have generally good agreement with PvCO 2 in hypocapnic and normocapnic intubated infants but there are some limitations especially with high level of CO 2 tension. Monitoring of PtCO 2 is generally a useful non-invasive indicator of PvCO 2 in hypocapnic and normocapnic infants.