Impact of Continuous Capnography in Ventilated Neonates: A Randomized, Multicenter Study

Kugelman, Amir; Golan, Agenta; Riskin, Arieh; Shoris, Irit; Ronen, Michal; Qumqam, Nelly; Bader, David A.; Bromiker, Ruben

doi:10.1016/j.jpeds.2015.09.051

Cited by 34 publications

(35 citation statements)

References 24 publications

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“…In the NICU population, gas sampled from the distal end of the endotracheal tube provides a good correlation with carbon dioxide in arterial blood. 7,10 However, consistent with the findings in older children, pulmonary disease is associated with poorer agreement between the 2 methods. 7 The accuracy of ET carbon dioxide monitoring for intraoperative use in newborn infants has not been extensively studied.…”

Section: Introductionsupporting

confidence: 71%

“…Most interestingly, the same studies clearly display a poorer agreement and larger bias in infants <1500 g and also conclude that ET monitoring is less useful when true pCO 2 is approaching undesirable levels . More recent data using a modified method for capnography, with gas sampling from the tip of a double‐lumen ET tube, suggests that capnography can be optimized to function adequately also in tiny infants with pulmonary disease.…”

Section: Discussionmentioning

confidence: 95%

“…Results from studies in the PICU report that ET measurement of carbon dioxide is a reliable estimate in children but that pulmonary disease and small tidal volumes negatively impact on the correlation between ET measurement and blood gas. In the NICU population, gas sampled from the distal end of the endotracheal tube provides a good correlation with carbon dioxide in arterial blood . However, consistent with the findings in older children, pulmonary disease is associated with poorer agreement between the 2 methods .…”

Section: Introductionmentioning

confidence: 93%

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Poor performance of main‐stream capnography in newborn infants during general anesthesia

Karlsson

Sporre

Hellström‐Westas

et al. 2017

Pediatric Anesthesia

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Section: Introductionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 93%

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Poor performance of main‐stream capnography in newborn infants during general anesthesia

Karlsson

Sporre

Hellström‐Westas

et al. 2017

Pediatric Anesthesia

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“…Lightweight infrared (IR) mainstream sensors with a dead space <1 mL enabled reliable measurements even in preterm infants [12–14]. In addition, special low-flow sidestream capnographs were developed for dead space free measurements in neonates, making long-term monitoring possible [15–17]. 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].…”

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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“…Neonates and infants are especially susceptible to CPA following acute respiratory decompensation. 16 Continuous capnography monitoring in NICU patients permits identification of elevated CO2 levels, 17 and capnography permits rapid identification of endotracheal tube dislodgement in intubated patients. 18 Enhanced respiratory monitoring with continuous capnography may therefore help providers recognize and prevent ARC, averting some cases of CPA in the NICU.…”

Section: Discussionmentioning

confidence: 99%

Incidence, characteristics, and survival following cardiopulmonary resuscitation in the quaternary neonatal intensive care unit

Foglia

Langeveld²,

Heimall

et al. 2017

Resuscitation

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Background The contemporary characteristics and outcomes of cardiopulmonary resuscitation (CPR) in the neonatal intensive care unit (NICU) are poorly described. The objectives of this study were to determine the incidence, interventions, and outcomes of CPR in a quaternary referral NICU. Methods Retrospective observational study of infants who received chest compressions for resuscitation in the Children’s Hospital of Philadelphia NICU between April 1, 2011 and June 30, 2015. Patient, event, and survival characteristics were abstracted from the medical record and the hospital-wide resuscitation database. The primary outcome was survival to hospital discharge. Univariable and multivariable analyses were performed to identify patient and event factors associated with survival to discharge. Results There were 1.2 CPR events per 1,000 patient days. CPR was performed in 113 of 5,046 (2.2%) infants admitted to the NICU during the study period. The median duration of chest compressions was 2 minutes (interquartile range 1, 6 minutes). Adrenaline was administered in 34 (30%) CPR events. Of 113 infants with at least one CPR event, 69 (61%) survived to hospital discharge. Factors independently associated with decreased survival to hospital discharge were inotrope treatment prior to CPR (adjusted Odds Ratio [aOR] 0.14, 95% Confidence Interval [CI] 0.04, 0.54), and adrenaline administration during CPR (aOR 0.14, 95% CI 0.04, 0.50). Conclusions Although it was not uncommon, the incidence of CPR was low (<3%) among infants hospitalized in a quaternary referral NICU. Infants receiving inotropic therapy prior to CPR and adrenaline administration during CPR were less likely to survive to hospital discharge.

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Impact of Continuous Capnography in Ventilated Neonates: A Randomized, Multicenter Study

Cited by 34 publications

References 24 publications

Poor performance of main‐stream capnography in newborn infants during general anesthesia

Poor performance of main‐stream capnography in newborn infants during general anesthesia

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

Incidence, characteristics, and survival following cardiopulmonary resuscitation in the quaternary neonatal intensive care unit

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