Failure to recognize esophageal intubation can result in severe hypoxia and permanent neurologic injury. Capnography is a standard monitoring modality in the operating room but has not been utilized fully in other environments. We used capnography at the time of endotracheal intubation in the neonatal intensive care unit (NICU) to determine whether capnography could more quickly and accurately identify endotracheal tube position than other clinical indicators of endotracheal tube position. One hundred intubation episodes were studied in 55 neonates. Capnograms were obtained 15 and 120 sec following tube placement. Intubating personnel were blinded to the capnographic data and determined endotracheal tube location (trachea vs. esophagus) by clinical criteria only. The sensitivity and specificity of capnography and clinical examination for identification of tube position were analyzed, and the time required for establishing by clinical confirmation whether the tube was in the trachea or not was compared to that required for capnography. Forty of 100 intubation attempts resulted in esophageal intubation. Capnography correctly identified these errant tube placements in 39 of 40 instances and did so in 1.6 sec (SD +/- 2.4). Capnography failed to identify successful endotracheal intubation on only one occasion. Clinical indicators of tube position required 97.1 sec (SD +/- 92.6) to identify an esophageal intubation and failed to identify successful endotracheal intubation in 5 of 60 cases. We conclude that capnography is a valuable adjunct to clinical examination to demonstrate whether an endotracheal tube is placed correctly in the trachea of neonates in the NICU.
Summary ated species of this phospholipid is believed to play a major role In lowering surface tension at the air-alveolar interface, thereby PC in the lungs of the fetuses of glucose-intolerant monkeys. InInsulin treatment had no effect on the rate of choline incorpoaddition, Moxley and L~~~~~~~ found ,hat glucose ration into phosphatidylcholine (PC) or disaturated PC and did into PC in isolated, perfused rat lungs was decreased not antagonize the dexamethasone-induced stimulation of choline when the lungs of adult diabetic rats were used. These effects incorporation into PC. When the incorporation of IVilacetate into be reversed by insulin treatment prior to perfusion. the various phospholipid fractions was examined, however, i t was of insulin action. which depend on isotope incorporation into found that exposure to insulin resulted i n a significant decrease i n phospholipids. are, however. complicated by t h e fact insulin the percentage of phospholipid radioactivity in the disaturated PC [he uptake of some substrates into cells and may also fraction and an increase i n the percentage of radioactivity i n the influence the intracellular pool size of these substrates, had the nppnsite effect to insulin with regard to acetate incorpo-phol,p,ds other than PC. was ~h~~~ included the imration into the various phospholipid fractions, and when the two portant surfactant components disaturated PC and phosphatidylhormones were combined, this effect was diminished or abolished. glycerol ( 19. I ) as well as the phosphol,p,dh usually The effects of insulin could not be accounted for on the basis of a with cell membranes. mono-and unsaturated PC.. phosphatidylchange i n activity of any of the enzymes of phospholipid synthesis elhanolamine, phosphat,dylinositol. phosphatidylserine. and that were examined. sphingomyelin (27). The influence of insulin on enzymes involvedThese findings suggest that insulin stimulates the synthesis of with pulmonary phospholipid synthesis was also examined, the cell membrane phospholipids while decreasing that of the surfactant phospholipid, disaturated PC.
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