Original ArticleImpact of Continuous Capnography in Ventilated Neonates: A Randomized, Multicenter Study
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
References (27)
- et al.
Hypocapnia and hypercapnia in respiratory management of newborn infants
Clin Perinatol
(2001) End-tidal carbon dioxide monitoring in pediatrics: clinical applications
J Postgrad Med
(2001)- et al.
Current limitations of volumetric capnography in surfactant-depleted small lungs
Pediatr Crit Care Med
(2004) - et al.
Accuracy of a new low-flow sidestream capnography technology in newborns: a pilot study
J Perinatol
(2002) - et al.
A novel method of distal end-tidal CO2 capnography in intubated infants: comparison with arterial CO2 and with proximal mainstream end-tidal CO2
Pediatrics
(2008) - et al.
Mainstream end-tidal carbon dioxide monitoring in the neonatal intensive care unit
Pediatrics
(1998) - et al.
Hypocarbia before surfactant therapy appears to increase bronchopulmonary dysplasia risk in infants with respiratory distress syndrome
Arch Pediatr Adolesc Med
(1995) - et al.
Hypocarbia and cystic periventricular leukomalacia in premature infants
Arch Dis Child
(1994) - et al.
Response of cerebral blood volume to changes in arterial carbon dioxide tension in preterm and term infants
Pediatr Res
(1991) - et al.
Perinatal factors and periventricularintraventricular hemorrhage in preterm infants
Am J Dis Child
(1986)
End-tidal carbon dioxide measurements in critically ill neonates: a comparison of side-stream and mainstream capnometers
Can J Anaesth
Sidestream microstream end-tidal carbon dioxide measurements and blood gas correlations in neonatal intensive care unit
Pediatr Pulmonol
Good estimation of arterial carbon dioxide by end-tidal carbon dioxide monitoring in the neonatal intensive care unit
Pediatr Pulmonol
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.