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Capnography for catheter location confirmation in minimally invasive surfactant administration



Minimally Invasive Surfactant Treatment (MIST) is a common method for administering surfactant as a treatment for respiratory distress syndrome. However, tracheal catheter placement can be difficult to confirm. We assessed the presence of carbon dioxide (CO2) in tracheal and esophageal gas aspirated using CO2 detector.

Study design

Retrospective arm: 20 infants, MIST catheter placement was assessed with a CO2 detector in two techniques and confirmed with clinical response. Prospective arm—10 infants, aimed to check for CO2 presence in aspirated esophageal gas during routine nasogastric tube insertion.


Retrospective arm: All infants had positive capnography. One infant that had no clinical response to MIST was diagnosed with total anomalous pulmonary venous return. All 10 infants of the prospective arm had a Negative capnography (P < 0.001, Fisher’s exact test).


Readily available CO2 detectors can distinguish between tracheal and esophageal placement of MIST catheters prior to MIST.

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Fig. 1: The two steps of the syringe technique for carbon dioxide assessment.
Fig. 2: Direct connection of MIST catheter to the ET tube.
Fig. 3

Data availability

We will provide study data upon a reasonable request.


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Author information

Authors and Affiliations



IN conceptualized and designed the study, wrote the study protocol, and reviewed and critically revised the manuscript. SA-R drafted the initial manuscript, performed some of the clinical tests and performed data collection and analysis. FRM and RAO helped in designing the study, and critically reviewed the manuscript for important intellectual content. DB-S and NA-L performed some of the clinical tests collected data.

Corresponding author

Correspondence to Itamar Nitzan.

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The authors declare no competing interests.

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Nitzan, I., Abu Omar, R., Mimouni, F.B. et al. Capnography for catheter location confirmation in minimally invasive surfactant administration. J Perinatol 43, 300–304 (2023).

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