Elsevier

The Journal of Pediatrics

Volume 168, January 2016, Pages 56-61.e2
The Journal of Pediatrics

Original Article
Impact of Continuous Capnography in Ventilated Neonates: A Randomized, Multicenter Study

Portions of the study were presented as an abstract at the meeting of the Pediatric Academic Societies, San Diego, CA, April 25-28, 2015.
https://doi.org/10.1016/j.jpeds.2015.09.051Get rights and content

Objective

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.

Study design

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.

Results

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) with PaCO2. Compared with infants in the masked group, those in the monitored group had significantly (P = .03) less time with an unsafe dETCO2 level (high: 3.8% vs 8.8% or low: 3.8% vs 8.9%). The prevalence of intraventricular hemorrhage or periventricular leukomalacia rate was lower in the monitored group (P = .02) and was significantly (P < .05) associated with the independent factors dETCO2 monitoring and gestational age.

Conclusion

Continuous dETCO2 monitoring improved control of CO2 levels within a safe range during conventional ventilation in a neonatal intensive care unit.

Trial registration

ClinicalTrials.gov: NCT01572272.

Section snippets

Methods

This randomized controlled study was conducted at 3 university-affiliated tertiary NICUs. Ventilated infants with a double-lumen ETT were randomized to either: (1) the open monitored (study) group, in which data from the capnograph were recorded, displayed to the medical team, and used for patient care; or (2) the masked (control) group, in which data from the capnograph were recorded. The measurements were masked and not available for patient care. The study was approved by the Israeli

Results

Infants were enrolled between February 2013 and October 2014. Of 68 eligible infants, 66 were randomized to the open or masked group (Figure 1; available at www.jpeds.com), and 2 were excluded owing to parental refusal. Three dropped out of the study because they had less than 3 ABG measurements while ventilated, and 8 were not included in the analysis because of technical problems with the recordings in parallel with dETCO2 measurements. Finally, 55 infants (25 open, 30 masked) were analyzed

Discussion

We have demonstrated that continuous dETCO2 monitoring improved the control of CO2 levels within a safe range during CV in the NICU. In the current era of permissive hypercapnia, infants spend more time at higher CO2 levels; yet, because ETCO2 underestimates PaCO2,4, 5 extra attention is warranted should the ETCO2 alarm indicate a high CO2 level. For the same reason, when setting an alarm, one should keep in mind that when the capnograph reads 30 mmHg, the PaCO2 is probably ≥35 mmHg, depending

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  • Cited by (0)

    Funded by Covidien Respiratory and Monitoring Solutions, Jerusalem, Israel. Devices and sampling lines used for measurement of dETCO2 were supplied by Covidien Respiratory and Monitoring Solutions, Jerusalem, Israel. M.R. is employed by Covidien. The other authors declare no conflicts of interest.

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