Mainstream End-tidal Carbon Dioxide Monitoring in the Neonatal Intensive Care Unit

Rozycki, Henry J.; Sysyn, Gregory; Marshall, M. Ernest; Malloy, Raymond; Wiswell, Thomas E.

doi:10.1542/peds.101.4.648

Cited by 93 publications

(74 citation statements)

References 29 publications

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“…Although the number of out-of-range Pa CO 2 values was not reduced, ET CO 2 was lower during ventilation than during breathing [95]. While studies in the neonatal intensive care unit have found that ET CO 2 closely correlates with Pa CO 2 [96,97,98], it is important not to extrapolate these findings to the situation in the delivery room, when the lung is partially liquid filled. The assumption that ET CO 2 will approximate Pa CO 2 levels relies on the fact that CO 2 exchange in the lung is not diffusion limited.…”

Section: Measurements For Evaluating Transitionmentioning

confidence: 99%

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Measuring Physiological Changes during the Transition to Life after Birth

Vonderen¹,

Roest

Siew

et al. 2014

Neonatology

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The transition to life after birth is characterized by major physiological changes in respiratory and hemodynamic function, which are predominantly initiated by breathing at birth and clamping of the umbilical cord. Lung aeration leads to the establishment of functional residual capacity, allowing pulmonary gas exchange to commence. This triggers a significant decrease in pulmonary vascular resistance, consequently increasing pulmonary blood flow and cardiac venous return. Clamping the umbilical cord also contributes to these hemodynamic changes by altering the cardiac preload and increasing peripheral systemic vascular resistance. The resulting changes in systemic and pulmonary circulation influence blood flow through both the oval foramen and ductus arteriosus. This eventually leads to closure of these structures and the separation of the pulmonary and systemic circulations. Most of our knowledge on human neonatal transition is based on human (fetal) data from the 1970s and extrapolation from animal studies. However, there is renewed interest in performing measurements directly at birth. By using less cumbersome techniques (and probably more accurate), our previous understanding of the physiological transition at birth is challenged, as well as the causes and consequences for when this transition fails to progress. This review will provide an overview of physiological measurements of the respiratory and hemodynamic transition at birth. Also, it will give a perspective on some of the upcoming technological advances in physiological measurements of neonatal transition in infants who are unable to make the transition without support.

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Section: Measurements For Evaluating Transitionmentioning

confidence: 99%

“…Gas exchange measurements during transition, using capnography, could assist in defining adequate tidal volumes [96,97,98] and the total amount of proper gas exchange. However, this technique can be influenced by other variables such as mask leak and the dead space of the mask and sensor.…”

Section: Conclusion and Future Perspectivesmentioning

confidence: 99%

Measuring Physiological Changes during the Transition to Life after Birth

Vonderen¹,

Roest

Siew

et al. 2014

Neonatology

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“…Four (n=723) assessed end-tidal CO 2 , one assessed transcutaneous CO 2 (n=46) and one assessed both (n=37). (41)(42)(43)(44)(45)(46) The correlation between blood CO 2 and noninvasive monitoring was acceptable (correlation coefficient 0.55 to 0.82). In infants with significant pulmonary disease, the end-tidal CO 2 partial pressure of CO 2 may be quite discrepant due to large dead space volumes.…”

Section: Does the Use Of Noninvasive Monitoring Inmentioning

confidence: 90%

Minimizing blood loss and the need for transfusions in very premature infants

Lemyre¹,

Sample²,

Lacaze‐Masmonteil³

2015

Paediatrics &Amp; Child Health

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“…19 A limitation of using ETCO 2 rather than arterial partial pressure of carbon dioxide is that there can be inaccuracies secondary to anesthetic gas flows, uncuffed endotracheal tubes, and ETCO 2 measurements. 20 …”

Section: Hypotension: Definitions In Young Infants and Occurrence Witmentioning

confidence: 99%

Infantile Postoperative Encephalopathy: Perioperative Factors as a Cause for Concern

McCann¹,

Schouten²,

et al. 2014

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We report on 6 infants who underwent elective surgery and developed postoperative encephalopathy, which had features most consistent with intraoperative cerebral hypoperfusion. All infants were ,48 weeks' postmenstrual age and underwent procedures lasting 120 to 185 minutes. Intraoperative records revealed that most of the measured systolic blood pressure (SBP) values were ,60 mm Hg (the threshold for hypotension in awake infants according to the Pediatric Advanced Life Support guidelines) but that only 11% of the measured SBP values were ,1 SD of the mean definition of hypotension (,45 mm Hg) as reported in a survey of members of the Society for Pediatric Anesthesia in 2009. Four infants also exhibited prolonged periods of mild hypocapnia (,35 mm Hg). One infant did not receive intraoperative dextrose. All infants developed new-onset seizures within 25 hours of administration of the anesthetic, with a predominant cerebral pathology of supratentorial watershed infarction in the border zone between the anterior, middle, and posterior cerebral arteries. Follow-up of these infants found that 1 died, 1 had profound developmental delays, 1 had minor motor delays, 2 were normal, and 1 was lost to follow-up. Although the precise cause of encephalopathy cannot be determined, it is important to consider the role that SBP hypotension (as well as hypoglycemia, hyperthermia, hyperoxia, and hypocapnia) plays during general anesthesia in young infants in the development of infantile postoperative encephalopathy. Our observations highlight the lack of evidence-based recommendations for the lower limits of adequate SBP and end-tidal carbon dioxide in anesthetized infants. Pediatrics 2014;133:e751-e757 AUTHORS:

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Mainstream End-tidal Carbon Dioxide Monitoring in the Neonatal Intensive Care Unit

Abstract: End-tidal CO2 monitoring in NICU patients is as accurate as capillary or transcutaneous monitoring but less precise than the latter. It may be useful for trending or for screening patients for abnormal arterial CO2 values.

Cited by 93 publications

References 29 publications

Measuring Physiological Changes during the Transition to Life after Birth

Measuring Physiological Changes during the Transition to Life after Birth

Minimizing blood loss and the need for transfusions in very premature infants

Infantile Postoperative Encephalopathy: Perioperative Factors as a Cause for Concern

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