At‐home end‐tidal carbon dioxide measurement in children with invasive home mechanical ventilation

Abstract

Background: Carbon dioxide concentration trending is used in chronic management of children with invasive home mechanical ventilation (HMV) in clinical settings, but options for end-tidal carbon dioxide (EtCO 2 ) monitoring at home are limited.We hypothesized that a palm-sized, portable endotracheal capnograph (PEC) that measures EtCO 2 could be adapted for in-home use in children with HMV. Methods: We evaluated the internal consistency of the PEC by calculating an intraclass correlation coefficient of three back-to-back breaths by children (0-17 years) at baseline health in the clinic. Pearson's correlation was calculated for PEC EtCO 2 values with concurrent mean values of in-clinic EtCO 2 and transcutaneous CO 2 (TCM) capnometers. The Bland-Altman test determined their level of agreement. Qualitative interviews and surveys assessed usability and acceptability by family-caregivers at home. Results: CO 2 values were collected in awake children in varied activity levels and positions (N = 30). The intraclass correlation coefficient for the PEC was 0.95 (p < 0.05). The correlation between the PEC and in-clinic EtCO 2 device was 0.85

Chronic critical patient in pediatrics: microbiological “portrait” and problems of antibiotic resistance

“…Усугубление тяжести клинических симптомов и неблагоприятные клинические исходы ассоциированы с мультирезистентными патогенами (табл. 2) [94].…”

“…(MIC >2 мкг/мЛ) и чувствительной к левофлоксацину (MIC ≤2 мкг/мл) бактериемией, вызванной Elizabethkingia meningoseptica, показало, что оценка по шкале APACHE II (ОШ 1,08; 95% ДИ 1,02-1,14; р = 0,008) была единственным независимым фактором риска развития резистентной к левофлоксацину бактериемии E. meningoseptica. Кроме того, 14-дневная летальность пациентов с левофлоксацинрезистентной бактериемией E. meningoseptica (р = 0,003) была значительно выше, чем у пациентов с патогеном, чувствительным к левофлоксацину [94].…”

Monitoring of physiologic features and treatment aspects of children on home invasive mechanical ventilation"

“…Overall, this device was demonstrated to show promise for spot-checking carbon dioxide levels in this population of children, but it has not been evaluated for continuous home monitoring purposes. (24) Similarly, there is little evidence for the use of ambulatory transcutaneous carbon dioxide monitoring (TCM) in children on home invasive ventilation. One study has been undertaken in children with neuromuscular disease to determine if ambulatory TCM monitoring could be used for early screening and diagnosis or nocturnal hypoventilation.…”

“…Therefore, at present further research is required before non-invasive CO 2 monitoring of any type can be recommended as part of routine home continuous routine monitoring. (24) The exception is in congenital central hypoventilation syndrome, a genetic condition where there is absent or abnormally reduced ventilatory responses to hypercapnia and hypoxia, in the context of systemic autonomic dysfunction. These patients fail to display the typical responses to hypoxia and/or hypercapnia such as increases in respiratory rate or effort.…”

The follow‐up of children on home invasive mechanical ventilation after hospital discharge

“…27 External monitoring can be performed through pulse oximetry, cardiorespiratory monitors, and/or end-tidal CO2 monitoring. [28][29][30] The statement of the ATS on this subject recommends that children on HIMV should be followed up using pulse oximetry. 7 On the other hand, the CTS recommends monitoring with pulse oximeters with a downloadable memory for patients with some special conditions such as those who are unable to wake up or breathe spontaneously when disconnected from a ventilator and patients with small tracheostomy tubes (<5 mm ID).…”