Noninvasive Capnometry for End-tidal Carbon Dioxide Monitoring via Nasal Cannula in Nonintubated Neonates

Tai, Chih-Che; Lu, Frank Leigh; Chen, Pau‐Chung; Jeng, Suh‐Fang; Chou, Hung-Chieh; Chen, Chien-Yi; Tsao, Po‐Nien; Hsieh, Wu‐Shiun

doi:10.1016/s1875-9572(10)60064-2

Cited by 13 publications

(11 citation statements)

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“…3,10 The increase in ETCO 2 to an average of 30 mmHg and to a maximum of 38 mmHg with a decrease of respiratory rate from 61 to 51 breaths per minute in our study may indicate bradypneic hypoventilation. 18,19,26 However, it is important to note that we measured only basal ETCO 2 and that our results do not provide information on the percentages of time during which ETCO 2 was above the expected levels. The equipment we used also does not allow quantitative measurement of tidal voulmes.…”

Section: Discussionmentioning

confidence: 77%

“…We also investigated the impact of chloral hydrate on the noninvasively measured ETCO 2 , which has been shown to be an accurate measure of ventilation in nonintubated newborns with normal respiratory function. [18][19][20] Changes of ETCO 2 during sedation with chloral hydrate have previously only been investigated in two retrospective studies, both of which included older children. 3,10 The increase in ETCO 2 to an average of 30 mmHg and to a maximum of 38 mmHg with a decrease of respiratory rate from 61 to 51 breaths per minute in our study may indicate bradypneic hypoventilation.…”

Section: Discussionmentioning

confidence: 99%

“…The noninvasive side-stream capnometry through nasal cannulas has previously been proven to be an accurate method for estimating ETCO 2 in nonintubated newborns without pulmonary disease. [18][19][20]…”

Section: Methodsmentioning

confidence: 99%

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Cardiorespiratory parameters in newborns during sedation with chloral hydrate

et al. 2020

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We commonly use chloral hydrate sedation in newborns, though its cardiorespiratory side effects have not yet been fully investigated. Our study aimed to analyze the impact of chloral hydrate on cardiorespiratory parameters in term newborns. We performed a prospective, pre-post single-arm interventional study in 42 term, respiratorily and hemodynamically stable newborns. Oxygen saturation (SpO 2), end-tidal CO 2 (ETCO 2), the apnea-hypopnea index and the respiratory and heart rates were recorded by polygraphy, starting 0.5-1 hour before oral administration of chloral hydrate at a dose of 40 mg/kg and ceasing 4 hours post-administration. After administration of chloral hydrate, the mean basal SpO 2 dropped by 2.0% (from 97.1% to 95.1%; p<0.001) and the mean basal ETCO 2 increased by 3.9 mmHg (25.6 to 29.5 mmHg; p<0.001). We found a significant decrease in the minimal SpO 2 values (p<0.001) and an increase in the percentage of time spent with SpO 2 <95% and <90% (p<0.001). The mean increase in the estimated apnea-hypopnea index was 3.5 events per hour (p<0.001). The mean respiratory and heart rates were significantly lower 150 min after the administration of chloral hydrate when compared with pre-sedation values (51/min and 127/min versus 61/min and 138/min respectively; p<0.001). A considerable number of patients exhibited changes in cardiorespiratory parameters that differed considerably from the normal ranges. In conclusion, SpO 2 , ETCO 2 , the estimated apnea-hypopnea index and the respiratory and heart rates changed after the administration of chloral hydrate. They remained within normal limits in most newborns, but the inter-individual variability was high in the studied population.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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Cardiorespiratory parameters in newborns during sedation with chloral hydrate

et al. 2020

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“… 19 In another study from Taiwan, 34 newborns followed up for respiratory distress were monitored with nasal capnography and a significant correlation between EtCO 2 and partial CO 2 in arterial blood gases was reported and the importance of the method was emphasized. 20 In the study by Flanagan and Tobias, 21 EtCO 2 measurements were made with nasal cannula in spontaneous breathing and it was determined that hypoventilation was characterized by an increase in the EtCO 2 levels. They reported that hypoxia was a later finding in the respiratory depression compared to hypercarbia.…”

Section: Discussionmentioning

confidence: 99%

Effects of Sedation and/or Sedation/Analgesic Drugs Administered during Central Venous Catheterization on the Level of End-tidal Carbon Dioxide Measured by Nasal Cannula in Our PICU

Aslan¹,

Yıldızdaş²,

Horoz³

et al. 2020

Indian Journal of Critical Care Medicine

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A bstract Aims and objectives Sedatives and analgesics are commonly used in pediatric intensive care units during minor invasive procedures. Here, we aimed to measure the changes in end-tidal carbon dioxide (EtCO 2 ) levels with different sedation/analgesic drug administrations (midazolam, ketamine, midazolam + ketamine/fentanyl) during central venous catheterization. Materials and methods This prospective study included 44 patients who needed sedation/analgesia for central venous catheterization. Patients were sedated with midazolam, ketamine, or midazolam + fentanyl/ketamine. End-tidal carbon dioxide values were measured before and after sedation–analgesia with nasal cannula and recorded from the capnograph. Oxygen saturation (SO 2 ) was monitored by pulse oximetry. Whether respiratory depression occurred during the process was recorded. Results During the procedure, 15 (34%) patients were given 0.1 mg/kg dose of midazolam described as group I, 18 (41%) patients were given 1 mg/kg dose of ketamine only described as group II, and 11 (25%) patients who could not be effective sedated with a single sedative–analgesic agent were given either 1 mg/kg dose of ketamine or 2 μg/kg dose of fentanyl together with 0.1 mg/kg dose of midazolam described as group III. According to our findings, hypoxia (54.5%) and hypercarbia (45.5%) were detected higher in group III but it was not statistically significant ( p = 0.255, p = 0.364). Hypercarbia was detected in 29.5% patients, in 62% of these patients hypercarbia was accompanied by hypoxia, and 38% had only hypercarbia. When presedation and postsedation EtCO 2 values were compared, we detected a statistically significant difference in all groups. Conclusion We detected hypercarbia unaccompanied by hypoxemia in 38% patients. And we think that we have identified these patients early due to measurement of EtCO 2 by nasal cannula. This study demonstrated that EtCO 2 monitoring via nasal cannula is a feasible and practical way to follow ventilation during sedation/analgesia. How to cite this article Aslan N, Yildizdas D, Horoz OO, Arslan D, Coban Y, Sertdemir Y. Effects of Sedation and/or Sedation/Analgesic Drugs Administered during Central Venous Catheterization on the Level of End-tidal Carbon Dioxide Measured by Nasal Cannula in Our PICU. Indian J Crit Care Med 2020;24(8):705–708.

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“…However, our method of matching the capnography monitor data with video recordings allowed us to eliminate most inaccurate readings, although this may not have been the case for all resuscitations. Although there is good correlation between PaCO 2 measurements and both mainstream16–20 and sidestream21 22 EtCO 2 measurements, it is important to note that EtCO 2 may not be as accurate in patients receiving facemask ventilation if there is a large leak present. Another limitation of our study is that the initial PCO 2 values obtained from both groups of infants within the first hour after birth may have been affected by other clinical interventions in the NICU occurring after immediate stabilisation.…”

Section: Discussionmentioning

confidence: 99%

Delivery room end tidal CO₂monitoring in preterm infants <32 weeks

Hawkes

Kenosi

Finn

et al. 2015

Arch Dis Child Fetal Neonatal Ed

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Noninvasive Capnometry for End-tidal Carbon Dioxide Monitoring via Nasal Cannula in Nonintubated Neonates

Abstract: End-tidal CO₂ measurement by side-stream capnometry through nasal cannula could provide an accurate and noninvasive estimate of PaCO₂ levels in nonintubated neonates.

Cited by 13 publications

References 35 publications

Cardiorespiratory parameters in newborns during sedation with chloral hydrate

Cardiorespiratory parameters in newborns during sedation with chloral hydrate

Effects of Sedation and/or Sedation/Analgesic Drugs Administered during Central Venous Catheterization on the Level of End-tidal Carbon Dioxide Measured by Nasal Cannula in Our PICU

Delivery room end tidal CO₂monitoring in preterm infants <32 weeks

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Noninvasive Capnometry for End-tidal Carbon Dioxide Monitoring via Nasal Cannula in Nonintubated Neonates

Abstract: End-tidal CO₂ measurement by side-stream capnometry through nasal cannula could provide an accurate and noninvasive estimate of PaCO₂ levels in nonintubated neonates.

Cited by 13 publications

References 35 publications

Cardiorespiratory parameters in newborns during sedation with chloral hydrate

Cardiorespiratory parameters in newborns during sedation with chloral hydrate

Effects of Sedation and/or Sedation/Analgesic Drugs Administered during Central Venous Catheterization on the Level of End-tidal Carbon Dioxide Measured by Nasal Cannula in Our PICU

Delivery room end tidal CO2monitoring in preterm infants <32 weeks

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Delivery room end tidal CO₂monitoring in preterm infants <32 weeks