Is waveform capnography reliable in neonates?

Scrivens, Alexandra; Zivanovic, Sanja; Roehr, Charles Christoph

doi:10.1136/archdischild-2018-316577

Cited by 10 publications

(10 citation statements)

References 28 publications

(20 reference statements)

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“…Therefore, exhaled carbon dioxide indicates effective gas exchange is occurring and it can be used as a surrogate marker of lung aeration. Capnography can be performed using qualitative or quantitative methods . Qualitative capnography uses a colorimetric device that changes colour when the expired carbon dioxide reaches a defined threshold.…”

Section: Resultsmentioning

confidence: 99%

“…Waveform capnography provides the clinician with detailed information, but is more difficult to interpret than colorimetric devices. There are concerns about the accuracy of waveform capnography in neonates, due to differences in ventilator settings, the frequent use of uncuffed tubes and relatively large dead space . Both qualitative and quantitative capnography are affected by airway obstruction, mask leaks and pulmonary blood flow.…”

Section: Resultsmentioning

confidence: 99%

“…Capnography is the measurement of exhaled carbon dioxide. 9 Carbon dioxide is produced by tissues undergoing oxidative metabolism and released into the blood stream. 10 It diffuses across the alveolar epithelium where it is removed from the body during exhalation.…”

Section: Capnographymentioning

confidence: 99%

“…Capnography can be performed using qualitative or quantitative methods. 9 Qualitative capnography uses a colorimetric device that changes colour when the expired carbon dioxide reaches a defined threshold.…”

Section: Key Notesmentioning

confidence: 99%

“…[18][19][20][21][22] A 2019 systematic review on the subject concluded that exhaled carbon dioxide was accurate at measuring trends in arterial carbon dioxide. 9 However, exhaled carbon dioxide tended to underestimate arterial carbon dioxide and may be less accurate than transcutaneous measurements at determining exact values, particularly in neonates with severe lung disease. The use of end-tidal carbon dioxide to indicate lung aeration is an area that requires further study.…”

Section: Key Notesmentioning

confidence: 99%

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Tools to assess lung aeration in neonates with respiratory distress syndrome

et al. 2019

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Aim Respiratory distress syndrome is a common condition among preterm neonates, and assessing lung aeration assists in diagnosing the disease and helping to guide and monitor treatment. We aimed to identify and analyse the tools available to assess lung aeration in neonates with respiratory distress syndrome. Methods A systematic review and narrative synthesis of studies published between January 1, 2004, and August 26, 2019, were performed using the OVID Medline, PubMed, Embase and Scopus databases. Results A total of 53 relevant papers were retrieved for the narrative synthesis. The main tools used to assess lung aeration were respiratory function monitoring, capnography, chest X‐rays, lung ultrasound, electrical impedance tomography and respiratory inductive plethysmography. This paper discusses the evidence to support the use of these tools, including their advantages and disadvantages, and explores the future of lung aeration assessments within neonatal intensive care units. Conclusion There are currently several promising tools available to assess lung aeration in neonates with respiratory distress syndrome, but they all have their limitations. These tools need to be refined to facilitate convenient and accurate assessments of lung aeration in neonates with respiratory distress syndrome.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Capnographymentioning

confidence: 99%

Section: Key Notesmentioning

confidence: 99%

Section: Key Notesmentioning

confidence: 99%

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Tools to assess lung aeration in neonates with respiratory distress syndrome

et al. 2019

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Assessment of sidestream end‐tidal capnography in ventilated infants on the neonatal unit

Williams

Dassios

Greenough

2020

Pediatric Pulmonology

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ObjectivesContinuous monitoring of carbon dioxide (CO2) levels can be achieved by capnography. Our aims were to compare the performance of a sidestream capnograph with a low dead space and sampling rate to a mainstream device and evaluate whether its results correlated with arterial/capillary CO2 levels in infants with different respiratory disease severities.Working HypothesesEnd‐tidal carbon dioxide (EtCO2) results by sidestream and mainstream capnography would correlate, but the divergence of EtCO2 and CO2 results would occur in more severe lung disease.Study DesignProspective cohort study.Patient‐subject SelectionFifty infants with a median (interquartile range) gestational age of 31.1 (27.1‐37.4) weeks and birth weight of 1.37 (0.76‐2.95) kg.MethodologyConcurrent measurements of EtCO2 in ventilated infants were made using a new Microstream sidestream device and a mainstream capnograph (gold standard). Results from both devices were compared with arterial or capillary CO2 levels. The ratio of dead space to tidal volume (Vd/Vt) was calculated to assess respiratory disease severity.ResultsThe mean difference between the concurrent measurements of EtCO2 was −0.54 ± 0.67 kPa (95% agreement levels − 1.86 to 0.77 kPa), the correlation between the two was r = .85 (P < .001). Sidestream capnography results correlated better with partial pressure of CO2 (PCO2) levels in infants with less (Vd/Vt < 0.35; r2 = .66, P < .001) rather than more severe (Vd/Vt > 0.35; r2 = .33, P = .01) lung disease.ConclusionsThe sidestream capnography performed similarly to the mainstream capnography. The poorer correlation of EtCO2 to PCO2 levels in infants with severe respiratory disease should highlight to clinicians increased ventilation‐perfusion mismatch.

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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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Is waveform capnography reliable in neonates?

Cited by 10 publications

References 28 publications

Tools to assess lung aeration in neonates with respiratory distress syndrome

Tools to assess lung aeration in neonates with respiratory distress syndrome

Assessment of sidestream end‐tidal capnography in ventilated infants on the neonatal unit

Carbon dioxide monitoring in the newborn infant

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