Performance of capnometry in non-intubated infants in the pediatric intensive care unit

BMC Pediatrics

Ranna A Rozenfeld²  Denise M Goodman²  Robin Chaize¹  Bria M Coates² 

[1] Joe DiMaggio Children’s Hospital, 1005 Joe DiMaggio Drive Hollywood, Florida 33021, USA;Division of Critical Care, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Box 73, Chicago, Illinois 60611, USA

关键词: Carbon dioxide;    Microstream;    Infants;    Monitoring;    Ventilation;    Capnometry;   

Others  :  1138673
DOI  :  10.1186/1471-2431-14-163

 received in 2013-11-11, accepted in 2014-06-19,  发布年份 2014

【 摘 要 】

Background

Assessing the ventilatory status of non-intubated infants in the Pediatric Intensive Care Unit (PICU) is a constant challenge. Methods to evaluate ventilation include arterial blood gas analysis (ABG), which is invasive and intermittent, and transcutaneous carbon dioxide monitoring (P_tcCO2), which, while non-invasive, is also intermittent. A method that is non-invasive and continuous would be of great benefit in this population. We hypothesized that non-invasive capnometry via sidestream monitoring of exhaled carbon dioxide (CO₂) would provide an acceptable measurement of ventilatory status when compared to ABG or P_tcCO2.

Methods

Preliminary prospective study of infants less than one year of age admitted to the PICU in a large urban teaching hospital. Infants not intubated and not requiring non-invasive ventilation were eligible. A sidestream CO₂ reading was obtained in a convenience sample of 39 patients. A simultaneous ABG was collected in those with an arterial catheter, and a P_tcCO2 was obtained in those without.

Results

Correlation of sidestream CO₂ with ABG was excellent (r² = 0.907). Sidestream correlated less well with P_tcCO2 (r² = 0.649). Results were not significantly altered when weight and respiratory rate were added as independent variables. Bland-Altman analysis revealed a bias of -2.7 with a precision of ±6.5 when comparing sidestream CO₂ to ABG, and a bias of -1.7 with a precision of ±9.9 when comparing sidestream CO₂ to P_tcCO2.

Conclusions

Performance of sidestream monitoring of exhaled CO₂ is acceptable clinical trending to assess the effectiveness of ventilation in non-intubated infants in the PICU.

【 授权许可】

   
2014 Coates et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Fouzas S, Priftis KN, Anthracopoulos MB: Pulse oximetry in pediatric practice. Pediatrics 2011, 128:740-752.
• [2]Monaco F, Nickerson BG, McQuitty JC: Continuous transcutaneous oxygen and carbon dioxide monitoring in the pediatric ICU. Crit Care Med 1982, 10:765-766.
• [3]Restrepo RD, Hirst KR, Wittnebel L, Wettstein R: AARC clinical practice guideline: transcutaneous monitoring of carbon dioxide and oxygen. Respir Care 2012, 2012:1955-1962.
• [4]Tobias JD: Transcutaneous carbon dioxide monitoring in infants and children. Pediatr Anesth 2009, 19:434-444.
• [5]Tobias JD, Wilson WR, Meyer DJ: Transcutaneous monitoring of carbon dioxide tension after cardiothoracic surgery in infants and children. Anesth Analg 1999, 88:531-534.
• [6]Eipe N, Doherty DR: A review of pediatric capnography. J Clin Monit Comput 2010, 24:261-268.
• [7]Tobias JD, Meyer DJ: Noninvasive monitoring of carbon dioxide during respiratory failure in toddlers and infants: end-tidal versus transcutaneous carbon dioxide. Anesth Analg 1997, 85:55-58.
• [8]Sivarajan VB, Bohn D: Monitoring of standard hemodynamic parameters: heart rate, systemic blood pressure, atrial pressure, pulse oximetry, and end-tidal CO2. Pediatr Crit Care Med 2011, 12:S2-S11.
• [9]McSwain SD, Hamel DS, Smith PB, Gentile MA, Srinivasan S, Meliones JN, Cheifetz IM: End-tidal and arterial carbon dioxide measurements correlate across all levels of physiologic dead space. Respir Care 2010, 55:288-293.
• [10]Bhende M: Capnography in the pediatric emergency department. Pediatr Emerg Care 1999, 15:64-69.
• [11]Yosefy C, Hay E, Nasri Y, Magen E, Reisin L: End tidal carbon dioxide as a predictor of the arterial PCO2 in the emergency department setting. Emerg Med J 2004, 21:557-559.
• [12]Kirk VG, Batuyong ED, Bohn SG: Transcutaneous carbon dioxide monitoring and capnography during pediatric polysomnography. Sleep 2006, 29:1601-1608.
• [13]Sullivan KJ, Kissoon N, Goodwin SR: End-tidal carbon dioxide monitoring in pediatric emergencies. Pediatr Emerg Care 2005, 21:327-332.
• [14]Langhan ML, Chen L: Current utilization of continuous end-tidal carbon dioxide monitoring in pediatric emergency departments. Pediatr Emerg Care 2008, 24:211-213.
• [15]Langhan M: Continuous end-tidal carbon dioxide monitoring in pediatric intensive care units. J Crit Care 2009, 24:227-230.
• [16]Price DD, Wilson SR, Fee ME: Sidestream end-tidal carbon dioxide monitoring during helicopter transport. Air Med J 2007, 26:55-59.
• [17]Krauss B, Hess DR: Capnography for procedural sedation and analgesia in the emergency department. Ann Emerg Med 2007, 50:172-181.
• [18]Lightdale JR, Goldmann DA, Feldman HA, Newburg AR, DiNardo JA, Fox VL: Microstream capnography improves patient monitoring during moderate sedation: a randomized, controlled trial. Pediatrics 2006, 117:e1170-e1178.
• [19]Nobel JJ: Carbon dioxide monitors, exhaled gas. Pediatr Emerg Care 1996, 12:239-240.
• [20]Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986, 1(8476):307-310.
• [21]Moses JM, Alexander JL, Agus MS: The correlation and level of agreement between end-tidal and blood gas pCO2 in children with respiratory distress: a retrospective analysis. BMC Pediatr 2009, 9:20. BioMed Central Full Text
• [22]Lopez E, Mathlouthi J, Lescure S, Krauss B, Jarreau PH, Moriette G: Capnography in spontaneously breathing preterm infants with bronchopulmonary dysplasia. Pediatr Pulmonol 2011, 46:896-902.
• [23]Fouzas S, Häcki C, Latzin P, Proietti E, Schulzke S, Frey U, Delgado-Eckert E: Volumetric capnography in infants with bronchopulmonary dysplasia. J Pediatr 2014, 164:283-288.
• [24]Jabre P, Jacob L, Auger H, Jaulin C, Monribot M, Aurore A, Margenet A, Marty J, Combes X: Capnography monitoring in nonintubated patients with respiratory distress. Am J Emerg Med 2009, 27:1056-1059.