Capnography in spontaneously breathing preterm infants with bronchopulmonary dysplasia

López, E.; Mathlouthi, Jihene; Lescure, Sandra; Krauss, Baruch; Jarreau, Pierre‐Henri; Moriette, G

doi:10.1002/ppul.21445

Cited by 17 publications

(11 citation statements)

References 23 publications

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“…This method detects a right shift of the oxygen dissociation curve and permits the degree of V/Q and/or right to left shunt to be estimated. Also, in other studies a higher gradient between capnography and capillary pCO 2 has been described in infants with BPD and a suggestion made that these can partly be attributed to a V/Q mismatch . However, a more objective way of describing the degree of lung physiologic impairment is to directly measure the reduced V/Q “mismatch” via SPECT.…”

Section: Discussionmentioning

confidence: 98%

“…Also, in other studies a higher gradient between capnography and capillary pCO 2 has been described in infants with BPD and a suggestion made that these can partly be attributed to a V/Q mismatch. 27 However, a more objective way of describing the degree of lung physiologic impairment is to directly measure the reduced V/Q ''mismatch'' via SPECT. Perhaps SPECT can be used to evaluate the reliability and usefulness of the alternative, non invasive methods.…”

Section: Alternatives To Spect For Bpd Gradingmentioning

confidence: 99%

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Bronchopulmonary dysplasia: Clinical grading in relation to ventilation/perfusion mismatch measured by single photon emission computed tomography

et al. 2013

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Bronchopulmonary dysplasia (BPD) is a significant cause of morbidity in the preterm population. Clinical severity grading based on the need for supplemental oxygen and/or need for positive airway pressure at 36 weeks postmenstrual age does not yield reproducible predictive values for later pulmonary morbidity. Single photon emission computed tomography (SPECT) was used to measure the distribution of lung ventilation (V) and perfusion (Q) in 30 BPD preterm infants at a median age of 37 weeks postmenstrual age. The V and Q were traced with 5 MBq Technegas and Technetium-labeled albumin macro aggregates, respectively, and the V/Q match-mismatch was used to quantify the extent of lung function impairment. The latter was then compared with the clinical severity grading at 36 weeks, and time spent on mechanical ventilation, continuous positive airway pressure (CPAP) and supplemental oxygen. Of those with mild and moderate BPD 3/9 and 3/11 patients, respectively, showed significant V/Q mismatches. By contrast, 4/10 patients with severe BPD showed a satisfactory V/Q matching distribution. An unsatisfactory V/Q match was not correlated with time spent on supplemental oxygen or CPAP, but was significantly negatively correlated with time spent on mechanical ventilation. SPECT provides unique additional information about regional lung function. The results suggest that the current clinical severity grading can be improved and/or complemented with SPECT.

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Section: Discussionmentioning

confidence: 98%

Section: Alternatives To Spect For Bpd Gradingmentioning

confidence: 99%

Bronchopulmonary dysplasia: Clinical grading in relation to ventilation/perfusion mismatch measured by single photon emission computed tomography

et al. 2013

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“…Additional studies in infants have examined the difference between sidestream CO 2 and capillary CO 2 , or used exhaled mainstream CO 2 to analyze the capnographic indices associated with bronchopulmonary dysplasia (BPD) [22,23]. One of the studies was consistent with our findings, showing good correlation between sidestream CO 2 and capillary CO 2 in preterm infants without lung disease [22]. However, the correlation between sidestream CO 2 and capillary CO 2 was lost in infants with BPD.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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BackgroundAssessing 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 (PtcCO2), 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 PtcCO2.MethodsPreliminary 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 PtcCO2 was obtained in those without.ResultsCorrelation of sidestream CO2 with ABG was excellent (r2 = 0.907). Sidestream correlated less well with PtcCO2 (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 PtcCO2.ConclusionsPerformance of sidestream monitoring of exhaled CO2 is acceptable clinical trending to assess the effectiveness of ventilation in non-intubated infants in the PICU.

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“…Several clinical studies have shown the clinical benefit of the time-based capnography in ventilated infants and children, e.g., for non-invasive monitoring of the arterial pCO 2 [18–20], to verify endotracheal tube placement [21–23], and to monitor the integrity of the ventilator circuit including disconnection and accidental extubation [24–26]. In spontaneously breathing infants time-based and volumetric capnography has been used for assessment of functional lung alterations related to bronchopulmonary dysplasia (BPD) [27–29]. Nevertheless the clinical use of capnography in newborns with the equipment available today still has methodological and technical problems which limits its wide adoption as a routine tool in the neonatal intensive care.…”

Section: Introductionmentioning

confidence: 99%

Current methodological and technical limitations of time and volumetric capnography in newborns

Schmalisch

2016

BioMed Eng OnLine

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Although capnography is a standard tool in mechanically ventilated adult and pediatric patients, it has physiological and technical limitations in neonates. Gas exchange differs between small and adult lungs due to the greater impact of small airways on gas exchange, the higher impact of the apparatus dead space on measurements due to lower tidal volume and the occurrence of air leaks in intubated patients. The high respiratory rate and low tidal volume in newborns, especially those with stiff lungs, require main-stream sensors with fast response times and minimal dead-space or low suction flow when using side-stream measurements. If these technical requirements are not fulfilled, the measured end-tidal CO2 (PetCO2), which should reflect the alveolar CO2 and the calculated airway dead spaces, can be misleading. The aim of this survey is to highlight the current limitations of capnography in very young patients to avoid pitfalls associated with the interpretation of capnographic parameters, and to describe further developments.

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Capnography in spontaneously breathing preterm infants with bronchopulmonary dysplasia

Abstract: Compared with healthy infants, a higher PcCO(2) -EtCO(2) gradient was observed in infants with BPD, suggesting that ventilation-perfusion mismatch may be present in these infants. The capnogram did not exhibit the characteristic shape of airway obstruction.

Cited by 17 publications

References 23 publications

Bronchopulmonary dysplasia: Clinical grading in relation to ventilation/perfusion mismatch measured by single photon emission computed tomography

Bronchopulmonary dysplasia: Clinical grading in relation to ventilation/perfusion mismatch measured by single photon emission computed tomography

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

Current methodological and technical limitations of time and volumetric capnography in newborns

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