Detection of exhaled carbon dioxide following intubation during resuscitation at delivery

Abstract

The time for ETCO to be detected following intubation in the delivery suite is variable emphasising the importance of using clinical indicators to assess correct endotracheal tube position in addition to ETCO monitoring. Capnography is likely to detect ETCO faster than colorimetric devices.

Quantitative end‐tidal carbon dioxide at initiation of resuscitation may help guide the ventilation of infants born at less than 30 weeks gestation

“…et al reported that the median time to detect any EtCO 2 following endotracheal intubation was 3.7 s (0-44). 9 The median time to reach 4 mmHg was 5.3 s (0-727) and to reach 15 mmHg was 8.1 s (0-827). This was comparable to our study that showed 11.5 and 18.0 s respectively.…”

“…Colorimetric CO 2 may be falsely negative for low cardiac output, suboptimal tidal volumes, airways obstruction or mask leak. Quantitative capnography could determine estimation of CO 2 quicker than colorimetric capnography 9 . In a randomised controlled trial of continuous quantitative CO 2 monitoring versus clinical assessment of preterm infants receiving positive pressure ventilation (PPV) via mask, there was no difference in EtCO 2 at the end of resuscitation 10 …”

“…Quantitative capnography could determine estimation of CO 2 quicker than colorimetric capnography. 9 In a randomised controlled trial of continuous quantitative CO 2 monitoring versus clinical assessment of preterm infants receiving positive pressure ventilation (PPV) via mask, there was no difference in EtCO 2 at the end of resuscitation. 10 The feasibility of use of quantitative EtCO 2 in the delivery suite has been established, although clinical utility of this data is yet to be determined.…”

Non‐invasive carbon dioxide monitoring in the UK: a survey of practice within neonatal intensive care

“…Indeed, one colorimetric ETCO 2 device was shown to be 91% sensitive and 100% specific in confirming tracheal tube placement during neonatal resuscitation [5]. Quantitative waveform analysis during newborn resuscitation has, however, been shown to detect ETCO 2 more rapidly than qualitative methods [6].…”

Carbon dioxide monitoring in the newborn infant

“…Assessment of respiratory flow waves in association with colorimetric CO 2 detectors during resuscitation of preterm infants (<32 weeks) suggested that colorimetric devices might mislead clinicians during intubation attempts, with 31% failing to change color despite the presence of flow waves depicting correct ETT placement 56 . Furthermore, resuscitation studies have reported that the median time for EtCO 2 to be detected via quantitative waveform capnography is 3.7 s, faster than reaching the thresholds for color change in qualitative methods of analysis such as the colorimetric device (5.3 s to reach 4 mmHg and 8.1 s to reach 15 mmHg), suggesting that quantitative capnography is superior in clinical practice 57 . This study however utilized as a comparison to waveform capnography the manufacturer stated times for colorimetric devices to change color, and indeed the two monitoring methods (quantitation vs. qualitative) have not been directly compared during resuscitation of newborn infants.…”