Results from capnography studies in adults may not apply to neonates

Tinnion, Robert; Mactier, Helen; Morley, C J; Roehr, Charles Christoph; Jackson, Aaron; Wardle, Stephen P.

doi:10.1136/bmj.l1338

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…Moreover, a recent framework from the British Association of Perinatal Medicine (BAPM) recommends the use of exhaled carbon dioxide monitoring during all neonatal intubation 22 . Concern exists, however, regarding the reliability of noninvasive modes of monitoring in neonates, especially those born extremely prematurely or of very low birth weight 23,24 . Indeed newborn infants often have rapid breathing rates, short expiratory times, and small tidal volumes which can pose challenges in the monitoring of exhaled CO 2 levels 25 .…”

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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Section: Introductionmentioning

confidence: 99%

Carbon dioxide monitoring in the newborn infant

Williams

Dassios

Greenough

2021

Pediatric Pulmonology

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“…Capnography is a non-invasive method for monitoring the concentration of exhaled carbon dioxide (CO 2 ) with proven benefits to patient safety (Eipe and Doherty 2010). Tidal capnography has been considered problematic in neonatal intensive care because of technical limitations relating to the specific characteristics of the newborn lungs (Tinnion et al 2019). A very high respiratory rate was thought to impede the formation of an alveolar plateau phase, while the relatively high dead space of main-stream capnographs underestimated the measurements of exhaled CO 2 by significant rebreathing of apparatus dead space (Schmalisch 2016).…”

Section: Introductionmentioning

confidence: 99%

Volumetric capnography slopes in ventilated term and preterm infants

Dassios

Dixon²,

Williams

et al. 2020

Physiol. Meas.

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Objective: To assess whether the slopes of volumetric capnography differ in preterm compared to term-born ventilated newborn infants and whether they are related to gestational age and the duration of ventilation. Approach: The slopes of phase II (SII) and III (SIII) of volumetric capnographs were measured in ventilated term and preterm infants at King’s College Hospital NHS Foundation Trust. The correlations of the slopes with gestational age (GA), duration of invasive ventilation and fraction of inspired oxygen (FIO2) were assessed. The slopes were normalised by multiplying the results with the expiratory tidal volume (VT) measurement. Main results: Fifty-six infants (44 preterm) were assessed. The preterm infants had a median (IQR) gestational age of 26 (25–29) weeks and were ventilated for 8 (3–32) days with a VT of 5.4 (4.1–6.8) ml kg−1. The term infants had a gestational age of 39 (37–40) weeks and were ventilated for 1 (1–6) day with a VT of 4.0 (3.6–5.3) ml kg−1. The SII (85.9 (76.2–98.4) mmHg) and SIII (16.5(10.0–21.9) mmHg) of the preterm infants were not significantly different compared to the SII (88.0 (74.6–110.0) mmHg) and SIII (13.5 (9.2–15.9) mmHg) of term infants (p = 0.625 and p = 0.144 respectively). SII was not significantly related to GA, duration of ventilation or FIO2. SIII was positively related to the duration of ventilation (r = 0.729, p < 0.001) and FIO2 (r = 0.704, p < 0.001). Significance: The volumetric capnography phase III slope was steeper in infants with higher ventilatory requirements, hence could potentially be used as an index of disease severity in ventilated newborns.

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“…The results of that survey [1] were thus met with scepticism from members of the British Association of Perinatal Medicine (BAPM), which highlighted differences in physiological characteristics of newborn infants compared with adults. Furthermore, BAPM emphasised alternative techniques in determining intubation success in neonates, such as qualitative colorimetric devices, flow sensors and clinical judgement [2]. The development of devices more suitable for use in newborns has subsequently provided clinicians with the means to continuously and non-invasively monitor carbon dioxide during resuscitation and mechanical ventilation.…”

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confidence: 99%