PET_CO2measurement and feature extraction of capnogram signals for extubation outcomes from mechanical ventilation

Abstract

Capnography is a continuous and noninvasive method for carbon dioxide (CO2) measurement, and it has become the standard of care for basic respiratory monitoring for intubated patients in the intensive care unit. In addition, it has been used to adjust ventilatory parameters during mechanical ventilation (MV). However, a substantial debate remains as to whether capnography is useful during the process of weaning and extubation from MV during the postoperative period. Thus, the main objective of this study was to present a new use for time-based capnography data by measuring the end-tidal CO2 pressure ([Formula: see text]), partial pressure of arterial CO2 ([Formula: see text]) and feature extraction of capnogram signals before extubation from MV to evaluate the capnography as a predictor of outcome extubation in infants after cardiac surgery. Altogether, 82 measurements were analysed, 71.9% patients were successfully extubated, and 28.1% met the criteria for extubation failure within 48 h. The ROC-AUC analysis for quantitative measure of the capnogram showed significant differences (p < 0.001) for: expiratory time (0.873), slope of phase III (0.866), slope ratio (0.923) and ascending angle (0.897). In addition, the analysis of [Formula: see text] (0.895) and [Formula: see text] (0.924) obtained 30 min before extubation showed significant differences between groups. The [Formula: see text] mean value for success and failure extubation group was 39.04 mmHg and 46.27 mmHg, respectively. It was also observed that high CO2 values in patients who had returned MV was 82.8 ± 21 mmHg at the time of extubation failure. Thus, [Formula: see text] measurements and analysis of features extracted from a capnogram can differentiate extubation outcomes in infant patients under MV, thereby reducing the physiologic instability caused by failure in this process.

Role of Integrated Pulmonary Index in Identifying Extubation Failure

“…Research studies in a pediatric population have shown that higher P ETCO 2 value is associated with failed extubation outcome. 13 The IPI algorithm includes P ETCO 2 measurement in its calculation and hence provides a noninvasive method to monitor ventilation status in patients postextubation.…”

Capnography and Pulse Oximetry Improve Fast Track Extubation in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial

“…Capnography in certain conditions, for instance con rmation of the correct place of the endotracheal tube, is recommended as the standard of care (Cumming and McFadzean 2005). Yet in some other circumstances, such as cardiopulmonary resuscitation and changing the MV settings, there are numerous differences between the existing data and there are no similar recommendations (Turle et al 2015, Pantazopoulos et al 2015, Rasera et al 2015. Certain studies have mentioned the lack of correlation between these variables and have considered the difference between them high (Warner et al 2009).…”

Digitization and Analysis of Capnography Using Image Processing Technique

“…Expiratory to Inspiratory Ratio (ETIR) Calculations were coded via functions and equations into MATLAB accordingly. The S1 was the gradient slope where the capnogram signal starts at 4 mmHg for 0.25 s on phase II of the capnogram (7,20). Meanwhile, S2 was the gradient slope from 0.75 to 1.25 s (7,21).…”