End-tidal capnography monitoring in infants ventilated on the neonatal intensive care unit

Williams, Emma; Dassios, Theodore; O’Reilly, Niamh; Walsh, Alison; Greenough, Anne

doi:10.1038/s41372-021-00978-y

Cited by 10 publications

(4 citation statements)

References 23 publications

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“…This monitoring was also associated with a reduction in the delta PaCO 2 levels (calculated from blood gases values as the difference between the highest and lowest PaCO 2 values) on day 1 after birth (1.4 [1.1–3.0] kPa vs. 3.7 [1.8–6.2] kPa; p = 0.002) and on day 4 (1.1 [0.6–1.5] kPa vs. 1.5 [0.5–2.6] kPa; p = 0.049). No significant difference was found in the number of blood gas samples between the pre‐ and post‐etCO 2 introduction era and there was no reduction in severe (grade III and IV) intraventricular haemorrhage (IVH) in the etCO 2 group 26 …”

Section: Resultsmentioning

confidence: 95%

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Capnometry during neonatal transport—Mini review

et al. 2023

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Monitoring critically ill, ventilated neonates during ground or air inter-hospital transport can be challenging. Pulse oximetry is an established non-invasive method to continuously monitor oxygenation, but there is also a need to monitor ventilation by assessing the clearance of carbon dioxide. Monitoring carbon dioxide levels is essential as both hypocarbia and hypercarbia in term and preterm infants are associated with lung and brain morbidities (bronchopulmonary dysplasia, peri/intraventricular haemorrhage and cystic periventricular leukomalacia). [1][2][3][4][5][6] Obtaining blood gases (incl. pCO 2; partial pressure of carbon dioxide), the gold standard method in neonatal intensive care, is not feasible during neonatal transport. Therefore, alternative methods of carbon dioxide monitoring need to be considered. They include the measurement of partial pressure of end-tidal carbon dioxide (etCO 2 ), also called capnometry. Apart from continuous carbon dioxide monitoring, a valuable feature of capnometry is rapid recognition of accidental extubation, which makes capnometry-together with its noninvasiveness, portability, and relative inexpensiveness-suitable

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Section: Resultsmentioning

confidence: 95%

“…No significant difference was found in the number of blood gas samples between the pre-and post-etCO 2 introduction era and there was no reduction in severe (grade III and IV) intraventricular haemorrhage (IVH) in the etCO 2 group. 26…”

Section: Key Notesmentioning

confidence: 99%

Capnometry during neonatal transport—Mini review

et al. 2023

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“…However, because capnography is performed in an offline manner, these capabilities have not been included in capnography in a clinical environment. Furthermore, it is costly and inconvenient and has a poor estimation of lung ventilation and perfusion state (Williams et al 2021 ). As a result, a lightweight, low-cost, precise, and quantitative CO 2 measurement instrument is urgently needed.…”

Section: Introductionmentioning

confidence: 99%

Highly sensitive and selective colorimetric sensing of CO2 for biomedical applications

et al. 2022

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The concentration of carbon dioxide (CO2) in unhealthy people differs greatly from healthy people. High-precision CO2 detection with a quick response time is essential for many biomedical applications. A major focus of this research is on the detection of CO2, one of the most important health biomarkers. We investigated a low-cost, flexible, and reliable strategy by using dyes for colorimetric CO2 sensing in this study. The impacts of temperature, pH, reaction time, reusability, concentration, and dye selectivity were studied thoroughly. This study described real-time CO2 analysis. Using this multi-dye method, we got an average detection limit of 1.98 ppm for CO2, in the range of 50–120 ppm. A portable colorimetric instrument with a smartphone-assisted unit was constructed to determine the relative red/green/blue values for real-time and practical applications within 15 s of interaction and the readings are very similar to those of an optical fiber probe. Environmental and biological chemistry applications are likely to benefit greatly from this unique approach.

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“…Various modalities of noninvasive monitoring are used clinically in adult and pediatric intensive care units, with the development of novel devices being integrated into the neonatal setting 19 . The use of continuous CO 2 monitoring on the neonatal intensive care unit has been utilized to reduce hypercapnia and the degree of fluctuation in PCO 2 levels during the first day after birth 20 . Furthermore, monitoring of carbon dioxide during initial resuscitation of premature infants at birth established that fluctuations of end‐tidal CO 2 levels (≥36.8 mmHg) were predictive of any IVH development with 96.5% sensitivity and 83.3% specificity 21 .…”

Section: Introductionmentioning

confidence: 99%

Carbon dioxide monitoring in the newborn infant

Williams

Dassios

Greenough

2021

Pediatric Pulmonology

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Carbon dioxide (CO2) monitoring is vital during mechanical ventilation of newborn infants, as morbidity increases when CO2 levels are inappropriate. Our aim was to review the uses and limitations of such noninvasive monitoring methods. Colorimetry is primarily utilized during resuscitation to determine whether successful intubation has occurred. False negative and positive results can however lead to delays in detecting tracheal versus esophageal intubation. Transcutaneous carbon dioxide sensors have limited use during resuscitation, but can be utilized to provide continuous trend data during on‐going ventilation. End‐tidal capnography can provide clinicians with quantitative end‐tidal CO2 (EtCO2) values and a continuous real‐time capnogram waveform trace. These devices are becoming more widely accepted for use in the neonatal population as the new devices are lightweight with minimal additional dead space. Nevertheless, they have been reported to have variable accuracy when compared to arterial CO2 measurements, however, divergence of results may be related to disease severity rather than technological limitations. During resuscitation EtCO2 can be detected by capnography more rapidly than by colorimetry. Furthermore, capnography can be currently utilized in neonatal research settings to determine the physiological dead space and ventilation inhomogeneity, and thus has potential to be beneficial to clinical care. In conclusion, novel modes of noninvasive carbon dioxide monitoring can be safely and reliably utilized in newborn infants during mechanical ventilation. Future randomized trials should aim to address which device provides the most optimal form of monitoring in different clinical contexts.

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End-tidal capnography monitoring in infants ventilated on the neonatal intensive care unit

Cited by 10 publications

References 23 publications

Capnometry during neonatal transport—Mini review

Capnometry during neonatal transport—Mini review

Highly sensitive and selective colorimetric sensing of CO2 for biomedical applications

Carbon dioxide monitoring in the newborn infant

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