Abstract
Background: Non-invasive carbon dioxide (CO2) monitoring in mechanically-ventilated preterm babies in the first few days of life is essential during neonatal stabilisation/transport. This helps to keep CO2 levels in an acceptable range avoiding the risks associated with hypo- and hypercarbia, and minimises repeated arterial sampling and its associated complications. End-tidal CO2 (EtCO2) monitoring is of value in identifying certain ventilation problems, and proven to be effective in children and adults. The reports of its use in neonates are controversial.
Objective: To assess the accuracy of measurements of EtCO2 during neonatal transport of mechanically-ventilated preterm infants as compared with the partial pressure of arterial CO2 (PaCO2) measurements collected simultaneously.
Design: Retrospective study on 221 paired EtCO2/PaCO2 recordings taken during stabilisation/road transport of 125 mechanically-ventilated PT infants. The paired CO2 values were compared and the differences between both were analysed. The Bland-Altman method was used to assess bias and repeatability.
Results: EtCO2 correlated significantly with PaCO2. However, the correlation was extremely poor (r=0.39, p< 0.0001, 95% limits of agreement: 0.1996 - 0.4428). EtCO2 underestimated PaCO2 at a significant level (mean [SD] 2.595 [1.418] kPa), and did not trend reliably over time within individual subjects (r=0.15, p=0.12). The EtCO2 bias was independent of the PaCO2 level range and lung disease severity in terms of gas exchange or shunting. After correction of EtCO2 with the mean bias, 58% of EtCO2 values fell within 1 kPa of PaCO2 values.
Conclusions: EtCO2 has an unacceptable under-recording bias when compared to the simultaneous PaCO2 value.
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Abdelhamid, A., Ratnavel, N. & Sinha, A. Accuracy of Main-Stream End-Tidal Carbon Dioxide Measurement during the Road Transport of Mechanically-Ventilated Preterm Infants. Pediatr Res 70 (Suppl 5), 599 (2011). https://doi.org/10.1038/pr.2011.824
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DOI: https://doi.org/10.1038/pr.2011.824