1
|
Setar L, Lee JG, Sanchez-Pinto LN, Coates BM. Accuracy and Interpretation of Transcutaneous Carbon Dioxide Monitoring in Critically Ill Children. Pediatr Crit Care Med 2024:00130478-990000000-00361. [PMID: 38935571 DOI: 10.1097/pcc.0000000000003564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
OBJECTIVES Transcutaneous carbon dioxide (Tcco2) monitoring can noninvasively assess ventilation by estimating carbon dioxide (CO2) levels in the blood. We aimed to evaluate the accuracy of Tcco2 monitoring in critically ill children by comparing it to the partial pressure of arterial carbon dioxide (Paco2). In addition, we sought to determine the variation between Tcco2 and Paco2 acceptable to clinicians to modify patient care and to determine which patient-level factors may affect the accuracy of Tcco2 measurements. DESIGN Retrospective observational cohort study. SETTING Single, quaternary care PICU from July 1, 2012, to August 1, 2020. PATIENTS Included participants were admitted to the PICU and received noninvasive ventilation support (i.e., continuous or bilevel positive airway pressure), conventional mechanical ventilation, or high-frequency oscillatory or percussive ventilation with Tcco2 measurements obtained within 15 minutes of Paco2 measurement. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Three thousand four hundred seven paired arterial blood gas and Tcco2 measurements were obtained from 264 patients. Bland-Altman analysis revealed a bias of -4.4 mm Hg (95% CI, -27 to 18.3 mm Hg) for Tcco2 levels against Paco2 levels on the first measurement pair for each patient, which fell within the acceptable range of ±5 mm Hg stated by surveyed clinicians, albeit with wide limits of agreement. The sensitivity and specificity of Tcco2 to diagnose hypercarbia were 93% and 71%, respectively. Vasoactive-Infusion Score (VIS), age, and self-identified Black/African American race confounded the relationship between Tcco2 with Paco2 but percent fluid overload, weight-for-age, probe location, and severity of illness were not significantly associated with Tcco2 accuracy. CONCLUSIONS Tcco2 monitoring may be a useful adjunct to monitor ventilation in children with respiratory failure, but providers must be aware of the limitations to its accuracy.
Collapse
Affiliation(s)
- Leah Setar
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL
- Division of Pediatrics, Northwestern McGaw Medical Center, Chicago, IL
| | - Jessica G Lee
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL
- Division of Pediatrics, Northwestern McGaw Medical Center, Chicago, IL
| | - L Nelson Sanchez-Pinto
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL
- Division of Pediatrics, Northwestern McGaw Medical Center, Chicago, IL
| | - Bria M Coates
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL
- Division of Pediatrics, Northwestern McGaw Medical Center, Chicago, IL
| |
Collapse
|
2
|
Gangaram-Panday NH, van Essen T, van Weteringen W, Dremmen MHG, Goos TG, de Jonge RCJ, Reiss IKM. Transcutaneous carbon dioxide monitoring during therapeutic hypothermia for neonatal encephalopathy. Pediatr Res 2022; 92:1724-1730. [PMID: 35352004 DOI: 10.1038/s41390-022-02035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND In neonates with post-asphyxial neonatal encephalopathy, further neuronal damage is prevented with therapeutic hypothermia (TH). In addition, fluctuations in carbon dioxide levels have been associated with poor neurodevelopmental outcome, demanding close monitoring. This study investigated the accuracy and clinical value of transcutaneous carbon dioxide (tcPCO2) monitoring during TH. METHODS In this retrospective cohort study in neonates, agreement between arterial carbon dioxide (PaCO2) values and tcPCO2 measurements during TH was determined. TcPCO2 levels during the first 24 h of hypothermia were tested for an association with ischemic brain injury on magnetic resonance imaging (MRI). RESULTS Thirty-four neonates were included. Agreement (bias (95% limits of agreement)) between tcPCO2 and PaCO2 levels was 3.9 (-12.4-20.2) mm Hg. No relation was found between the body temperature and tcPCO2 levels. TcPCO2 levels differed significantly between patients with considerable and minimal damage on MRI; after 6 h (P = 0.02) and 9 h (P = 0.04). CONCLUSIONS Although tcPCO2 provided a limited estimation of PaCO2, it can be used for trend monitoring during TH. TcPCO2 levels after birth could provide an early indicator of ischemic brain injury. This relation should be investigated in large prospective studies, in which adjustments for confounders can be made. IMPACT Transcutaneous carbon dioxide measurements during therapeutic hypothermia in neonates show limited accuracy similar to measurements reported in normothermic neonates and can be used for trend monitoring. Low transcutaneous carbon dioxide levels during the first 24 h were associated with considerable ischemic brain injury on MRI. The value of transcutaneous carbon dioxide measurements during the first 24 h as an indicator of considerable ischemic brain injury on MRI should be investigated in future studies, adjusting for confounders. Transcutaneous oxygen measurements during therapeutic hypothermia showed an inaccuracy that could not be related to a low body temperature.
Collapse
Affiliation(s)
- Norani H Gangaram-Panday
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Tanja van Essen
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Willem van Weteringen
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marjolein H G Dremmen
- Department of Radiology and Nuclear Medicine, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tom G Goos
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Rogier C J de Jonge
- Pediatric Intensive Care Unit, Departments of Pediatrics and Pediatric Surgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
3
|
Moradian ST, Beitollahi F, Ghiasi MS, Vahedian-Azimi A. Capnography and Pulse Oximetry Improve Fast Track Extubation in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial. Front Surg 2022; 9:826761. [PMID: 35647019 PMCID: PMC9130597 DOI: 10.3389/fsurg.2022.826761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Use of capnography as a non-invasive method during the weaning process for fast track extubation (FTE) is controversial. We conducted the present study to determine whether pulse oximetry and capnography could be utilized as alternatives to arterial blood gas (ABG) measurements in patients under mechanical ventilation (MV) following coronary artery bypass graft (CABG) surgery. Methods In this randomized clinical trial, 70 patients, who were candidates for CABG surgery, were randomly assigned into two equal groups (n = 35), intervention and control group. In the intervention group, the ventilator management and weaning from MV was done using Etco2 from capnography and SpO2 from pulse oximetry. Meanwhile, in the control group, weaning was done based on ABG analysis. The length of intensive care unit (ICU) stay, time to extubation, number of manual ventilators setting changes, and alarms were compared between the groups. Results The end-tidal carbon dioxide (ETCO2) levels in the intervention group were completely similar to the partial pressure of carbon dioxide (PaCo2) in the control group (39.5 ± 3.1 vs. 39.4 ± 4.32, p > 0.05). The mean extubation times were significantly shorter in the intervention group compared to those in the control patients (212.2 ± 80.6 vs. 342.7 ± 110.7, p < 0.001). Moreover, the number of changes in the manual ventilator setting and the number of alarms were significantly lower in the intervention group. However, the differences in the length of stay in ICU between the two groups were not significant (p = 0.219). Conclusion Our results suggests that capnography can be used as an alternative to ABG. Furthermore, it is a safe and valuable monitor that could be a good alternative for ABG in this population. Further studies with larger sample sizes and on different disease states and populations are required to assess the accuracy of our findings. Clinical Trial Registration Current Controlled Trials, IRCT, IRCT201701016778N6, Registered 3 March 2017, https://www.irct.ir/trial/7192.
Collapse
Affiliation(s)
- Seyed Tayeb Moradian
- Atherosclerosis Research Center, Nursing Faculty, Baqiyatallah university of Medical Sciences, Tehran, Iran
| | - Fatemah Beitollahi
- Atherosclerosis Research Center, Nursing Faculty, Baqiyatallah university of Medical Sciences, Tehran, Iran
| | - Mohammad Saeid Ghiasi
- Atherosclerosis Research Center, Medicine Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Correspondence: Amir Vahedian-Azimi
| |
Collapse
|
4
|
Werther T, Aichhorn L, Stellberg S, Cardona FS, Klebermass-Schrehof K, Berger A, Schmölzer GM, Wagner M. Monitoring of carbon dioxide in ventilated neonates: a prospective observational study. Arch Dis Child Fetal Neonatal Ed 2022; 107:293-298. [PMID: 34344835 DOI: 10.1136/archdischild-2021-322138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/19/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the reliability, accuracy and precision of distal end-tidal capnography (detCO2) in neonates compared with transcutaneous (tcCO2) carbon dioxide measurements. DESIGN Observational, prospective clinical study. SETTING Neonatal intensive care unit at Medical University of Vienna. PARTICIPANTS Conventionally ventilated neonates with a body weight between 1000 g and 3000 g. INTERVENTION End-tidal partial pressure of CO2 was measured in distal position using the separate lumen of a double-lumen endotracheal tube connected to an external side-stream capnometer. Three consecutive detCO2 and tcCO2 values were recorded simultaneously and compared with simultaneous arterialised partial pressure of CO2 (paCO2) measurements in each patient. MAIN OUTCOME MEASURES Reliability, accuracy and precision of detCO2 and tcCO2 measurements compared with paCO2 in neonates. RESULTS Twenty-five neonates were included with a median (range) weight at enrolment of 1410 (1010-2980) g, from which 81 simultaneous measurements of detCO2, tcCO2 and paCO2 were obtained. The mean (SD) of paCO2, detCO2 and tcCO2 was 45.0 (8.6) mmHg, 42.4 (8.4) mmHg and 50.4 (20.4) mmHg, respectively. The intraclass correlation between paCO2 and detCO2 and between paCO2 and tcCO2 reached 0.80 (95% CI 0.71 to 0.87, p<0.001) and 0.59 (95% CI 0.43 to 0.72, p<0.001), respectively. In the Bland-Altman analysis, bias and precision of detCO2 with respect to paCO2 amounted to -2.68 mmHg and 10.62 mmHg (95% CI 8.49 to 14.51), respectively. Bias and precision of tcCO2 with respect to paCO2 amounted to 5.39 mmHg and 17.22 mmHg (95% CI 13.21 to 23.34), respectively. CONCLUSION DetCO2 had better reliability, accuracy and precision with paCO2 than tcCO2 in ventilated neonates without severe lung diseas. TRIAL REGISTRATION NUMBER NCT03758313.
Collapse
Affiliation(s)
- Tobias Werther
- Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Lukas Aichhorn
- Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Sina Stellberg
- Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Francesco Stefano Cardona
- Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Georg M Schmölzer
- Department of Pediatrics, Division of Neonatology, University of Alberta, Edmonton, Alberta, Canada.,Centre for the Studies of Asphyxia and Resuscitation, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Wagner
- Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
5
|
Martins IPM, Nakato AM, Hembecker PK, Ioshii SO, Nohama P. Correlation of End-Tidal Carbon Dioxide with Arterial Carbon Dioxide in Mechanically Ventilated Neonates: A Scoping Review. Glob Pediatr Health 2021; 8:2333794X211016790. [PMID: 34036124 PMCID: PMC8132087 DOI: 10.1177/2333794x211016790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/21/2021] [Indexed: 12/03/2022] Open
Abstract
Monitoring CO2 levels in intubated neonates is highly relevant in the face of complications associated with altered CO2 levels. Thus, this review aims to present the scientific evidence in the literature regarding the correlation between arterial carbon dioxide measured by non-invasive methods in newborns submitted to invasive mechanical ventilation. The search was carried out from January 2020 to January 2021, in the Scopus, Medline, The Cochrane Library, Web of Science, CINAHL and Embase databases. Also, a manual search of the references of included studies was performed. The main descriptors used were: "capnography," "premature infant," "blood gas analysis," and "mechanical ventilation." As a result, 221 articles were identified, and 18 were included in this review. A total of 789 newborns were evaluated, with gestational age between 22.8 and 42.2 weeks and birth weight between 332 and 4790 g. Capnometry was the most widely used non-invasive method. In general, the correlation and agreement between the methods evaluated in the studies were strong/high. The birth weight did not influence the results. The gestational age of fewer than 37 weeks implied, in its majority, a moderate correlation and agreement. Therefore, we can conclude that there was a predominance of a strong correlation between arterial blood gases and non-invasive methods, although there are variations found in the literature. Even so, the results were promising and may provide valuable data for future studies, which are necessary to consolidate non-invasive methods as a reliable and viable alternative to arterial blood gasometry.
Collapse
Affiliation(s)
| | - Adriane Muller Nakato
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Paula Karina Hembecker
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Sérgio Ossamu Ioshii
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Percy Nohama
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
- Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal do Paraná, Curitiba, Paraná, Brazil
| |
Collapse
|
6
|
Sankaran D, Zeinali L, Iqbal S, Chandrasekharan P, Lakshminrusimha S. Non-invasive carbon dioxide monitoring in neonates: methods, benefits, and pitfalls. J Perinatol 2021; 41:2580-2589. [PMID: 34148068 PMCID: PMC8214374 DOI: 10.1038/s41372-021-01134-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/25/2021] [Accepted: 06/09/2021] [Indexed: 01/21/2023]
Abstract
Wide fluctuations in partial pressure of carbon dioxide (PaCO2) can potentially be associated with neurological and lung injury in neonates. Blood gas measurement is the gold standard for assessing gas exchange but is intermittent, invasive, and contributes to iatrogenic blood loss. Non-invasive carbon dioxide (CO2) monitoring has become ubiquitous in anesthesia and critical care and is being increasingly used in neonates. Two common methods of non-invasive CO2 monitoring are end-tidal and transcutaneous. A colorimetric CO2 detector (a modified end-tidal CO2 detector) is recommended by the International Liaison Committee on Resuscitation (ILCOR) and the American Academy of Pediatrics to confirm endotracheal tube placement. Continuous CO2 monitoring is helpful in trending PaCO2 in critically ill neonates on respiratory support and can potentially lead to early detection and minimization of fluctuations in PaCO2. This review includes a description of the various types of CO2 monitoring and their applications, benefits, and limitations in neonates.
Collapse
Affiliation(s)
- Deepika Sankaran
- Division of Neonatology, Department of Pediatrics, University of California Davis, Sacramento, CA, USA.
| | - Lida Zeinali
- grid.27860.3b0000 0004 1936 9684Division of Neonatology, Department of Pediatrics, University of California Davis, Sacramento, CA USA
| | - Sameeia Iqbal
- grid.414164.20000 0004 0442 4003Division of Neonatology, Children’s Hospital of Orange County, Orange, CA USA
| | - Praveen Chandrasekharan
- grid.273335.30000 0004 1936 9887Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, NY USA
| | - Satyan Lakshminrusimha
- grid.27860.3b0000 0004 1936 9684Division of Neonatology, Department of Pediatrics, University of California Davis, Sacramento, CA USA
| |
Collapse
|
7
|
Duke-Novakovski T, Fujiyama M, Beazley SG. Comparison of mainstream (Capnostat 5) and two low-flow sidestream capnometers (VM-2500-S and Capnostream) in spontaneously breathing rabbits anesthetized with a Bain coaxial breathing system. Vet Anaesth Analg 2020; 47:537-546. [PMID: 32381351 DOI: 10.1016/j.vaa.2020.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate agreement with PaCO2 of two low sampling rate sidestream capnometers and a mainstream capnometer in rabbits and the effect of using high fresh gas flow from a Bain coaxial breathing system. STUDY DESIGN Prospective, crossover study. ANIMALS A total of 10 New Zealand White rabbits weighing 3.4 ± 0.3 kg [mean ± standard deviation (SD)]. METHODS Two sidestream analyzers (Viamed VM-2500-S and Capnostream 35) with a sampling rate of 50 mL minute-1 and a mainstream capnometer (Capnostat 5) were tested. All capnometers used infrared spectroscopy and advanced microprocessor technology. Rabbits were anesthetized and intubated with noncuffed endotracheal tubes of 3 mm internal diameter and adequate seal. A sidestream sampling adapter or the mainstream capnometer was attached to the endotracheal tube and connected to a Bain coaxial breathing system. Oxygen (1.5 L minute-1) delivered sevoflurane to maintain anesthesia. An auricular artery catheter allowed blood sampling for PaCO2 analysis corrected to rectal temperature. Inspired and end-tidal carbon dioxide (Pe'CO2) measurements were recorded during blood sample withdrawal. From each rabbit, 10 paired PaCO2/Pe'CO2 measurements were obtained. Each rabbit was recovered from anesthesia and was anesthetized again with an alternate capnometer after 1 week. Data were analyzed using Bland-Altman and two-way anova for repeated measures. RESULTS Analysis included 100 paired samples. Negative bias reflects underestimation of PaCO2. Bland-Altman mean (±1.95 SD) was -16.7 (-35.2 to 1.8) mmHg for Capnostat 5, -27.9 (-48.6 to -7.2) mmHg for Viamed, and -18.1 (-34.3 to -1.9) mmHg for Capnostream. Viamed PaCO2-Pe'CO2 gradient was greater than other two capnometers. CONCLUSIONS All three capnometers underestimated PaCO2. Capnostat 5 and Capnostream performed similarly. CLINICAL RELEVANCE These capnometers underestimated PaCO2 in spontaneously breathing rabbits anesthetized using a Bain coaxial breathing system with high fresh gas flows.
Collapse
Affiliation(s)
- Tanya Duke-Novakovski
- Department of Small Animal Clinical Studies, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Masako Fujiyama
- Department of Small Animal Clinical Studies, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Shannon G Beazley
- Department of Small Animal Clinical Studies, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| |
Collapse
|
8
|
Hochwald O, Borenstein-Levin L, Dinur G, Jubran H, Ben-David S, Kugelman A. Continuous Noninvasive Carbon Dioxide Monitoring in Neonates: From Theory to Standard of Care. Pediatrics 2019; 144:peds.2018-3640. [PMID: 31248940 DOI: 10.1542/peds.2018-3640] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 11/24/2022] Open
Abstract
Ventilatory support may affect the short- and long-term neurologic and respiratory morbidities of preterm infants. Ongoing monitoring of oxygenation and ventilation and control of adequate levels of oxygen, pressures, and volumes can decrease the incidence of such adverse outcomes. Use of pulse oximetry became a standard of care for titrating oxygen delivery, but continuous noninvasive monitoring of carbon dioxide (CO2) is not routinely used in NICUs. Continuous monitoring of CO2 level may be crucial because hypocarbia and hypercarbia in extremely preterm infants are associated with lung and brain morbidities, specifically bronchopulmonary dysplasia, intraventricular hemorrhage, and cystic periventricular leukomalacia. It is shown that continuous monitoring of CO2 levels helps in maintaining stable CO2 values within an accepted target range. Continuous monitoring of CO2 levels can be used in the delivery room, during transport, and in infants receiving invasive or noninvasive respiratory support in the NICU. It is logical to hypothesize that this will result in better outcome for extremely preterm infants. In this article, we review the different noninvasive CO2 monitoring alternatives and devices, their advantages and disadvantages, and the available clinical data supporting or negating their use as a standard of care in NICUs.
Collapse
Affiliation(s)
- Ori Hochwald
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and .,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Liron Borenstein-Levin
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil Dinur
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Huda Jubran
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shlomit Ben-David
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amir Kugelman
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
9
|
Scrivens A, Zivanovic S, Roehr CC. Is waveform capnography reliable in neonates? Arch Dis Child 2019; 104:711-715. [PMID: 31217206 DOI: 10.1136/archdischild-2018-316577] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Alexandra Scrivens
- Newborn Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | |
Collapse
|
10
|
Auten R, Ren C, Yilmaz O, Noah TL. Pediatric pulmonology year in review 2016: Part 2. Pediatr Pulmonol 2017; 52:1219-1225. [PMID: 28440920 PMCID: PMC7167696 DOI: 10.1002/ppul.23719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 04/03/2017] [Indexed: 12/14/2022]
Abstract
Pediatric Pulmonology continues to publish research and clinical topics related to the entire range of children's respiratory disorders. As we have done annually in recent years, we here summarize some of the past year's publications in our major topic areas, as well as selected literature in these areas from other core journals relevant to our discipline. This review (Part 2) covers selected articles on neonatology, asthma, physiology and lung function testing, and infectious diseases.
Collapse
Affiliation(s)
| | - Clement Ren
- Department of Pediatrics, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ozge Yilmaz
- Pediatric Allergy and Pulmonology, Celal Bayar University Department of Pediatrics, Manisa, Turkey
| | - Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|