Resistance of Colorimetric Carbon Dioxide Detectors Commonly Utilized in Neonates

Brown, Melissa K; Lazarus, Danielle; Gonzales, Sarah R.; Rich, Wade; Wozniak, Madeline; Poeltler, Debra; Katheria, Anup

doi:10.4187/respcare.04507

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…Thus, during the establishment of FRC, ECO 2 may not be detectable even if ventilation is adequate 1. Also, in vitro models show differences in resistance between devices used to detect ECO 2 during resuscitation of preterm infants 38. Although colorimetric ECO 2 devices are relatively simple and require no electricity, routine ECO 2 use during non-invasive ventilation at birth may increase costs.…”

Section: Discussionmentioning

confidence: 99%

Exhaled CO₂monitoring to guide non-invasive ventilation at birth: a systematic review

Monnelly

Josephsen

Isayama

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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ObjectiveMeasuring exhaled carbon dioxide (ECO2) during non-invasive ventilation at birth may provide information about lung aeration. However, the International Liaison Committee on Resuscitation (ILCOR) only recommends ECO2detection for confirming endotracheal tube placement. ILCOR has therefore prioritised a research question that needs to be urgently evaluated: ‘In newborn infants receiving intermittent positive pressure ventilation by any non-invasive interface at birth, does the use of an ECO2monitor in addition to clinical assessment, pulse oximetry and/or ECG, compared with clinical assessment, pulse oximetry and/or ECG only, decrease endotracheal intubation in the delivery room, improve response to resuscitation, improve survival or reduce morbidity?’.DesignSystematic review of randomised and non-randomised studies identified by Ovid MEDLINE, Embase and Cochrane CENTRAL search until 1 August 2022.SettingDelivery room.PatientsNewborn infants receiving non-invasive ventilation at birth.InterventionECO2measurement plus routine assessment compared with routine assessment alone.Main outcome measuresEndotracheal intubation in the delivery room, response to resuscitation, survival and morbidity.ResultsAmong 2370 articles, 23 were included; however, none had a relevant control group. Although studies indicated that the absence of ECO2may signify airway obstruction and ECO2detection may precede a heart rate increase in adequately ventilated infants, they did not directly address the research question.ConclusionsEvidence to support the use of an ECO2monitor to guide non-invasive positive pressure ventilation at birth is lacking. More research on the effectiveness of ECO2measurement in addition to routine assessment during non-invasive ventilation of newborn infants at birth is needed.PROSPERO registration numberCRD42022344849.

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Section: Discussionmentioning

confidence: 99%

Exhaled CO₂monitoring to guide non-invasive ventilation at birth: a systematic review

Monnelly

Josephsen

Isayama

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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“…Especially if a monitor is used, the flow transducer may increase but also display leakage. When the Pedi-Cap is used for monitoring non-invasive mask ventilation, clinicians should be aware of leaks compromising support and added resistance, described by Brown et al ,5 which could increase work of breathing.…”

Section: Discussionmentioning

confidence: 99%

Paediatric exhaled CO₂detector causes leaks

Martherus

Hoed

Cramer

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo assess leakage caused by the Pedi-Cap.MethodsBench test I: Pedi-Caps were connected between the Neopuff and a test lung and placed underwater to detect the leak. Bench test II: the disposable Avea VarFlex Flow Transducer measured the leak. Retrospective analysis: recordings of intubations in the delivery room were analysed.ResultsThe (rippled) male end of the Pedi-Cap is the origin of the leak. In bench test I, 32% of the Pedi-Caps caused inevitable extensive leaks and 34% caused leaks that diminished after sealing the end. In bench test II (n=44) and the retrospective analysis (n=17), the flow transducer measured 22% (18–60) and 39% (8–82) leakage, respectively. Leakage decreased after removal of the Pedi-Cap (before vs after; 17% (7–75) vs 4% (2–10), p=0.004).ConclusionThe Pedi-Cap causes the leak which can compromise respiratory support. We recommend to remove the Pedi-Cap directly after change of colour and to be cautious when using the device as evaluation tool.

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“…Colorimetric carbon dioxide detectors (e.g., Pedi‐CAPS; Covidien) contain a pH‐sensitive chemical indicator that changes color from purple to yellow as exhaled CO 2 is detected. Such qualitative change reflects adequate ventilation and establishment of pulmonary circulation 26 . Change is detected after as little as six exhaled breaths 27 and yellow color change commences at a minimum fraction of expired EtCO 2 of 0.5% (3.8 mmHg) with maximal change when above 2% or 15 mmHg 28 .…”

Section: Introductionmentioning

confidence: 98%

Carbon dioxide monitoring in the newborn infant

Williams

Dassios

Greenough

2021

Pediatric Pulmonology

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Carbon dioxide (CO2) monitoring is vital during mechanical ventilation of newborn infants, as morbidity increases when CO2 levels are inappropriate. Our aim was to review the uses and limitations of such noninvasive monitoring methods. Colorimetry is primarily utilized during resuscitation to determine whether successful intubation has occurred. False negative and positive results can however lead to delays in detecting tracheal versus esophageal intubation. Transcutaneous carbon dioxide sensors have limited use during resuscitation, but can be utilized to provide continuous trend data during on‐going ventilation. End‐tidal capnography can provide clinicians with quantitative end‐tidal CO2 (EtCO2) values and a continuous real‐time capnogram waveform trace. These devices are becoming more widely accepted for use in the neonatal population as the new devices are lightweight with minimal additional dead space. Nevertheless, they have been reported to have variable accuracy when compared to arterial CO2 measurements, however, divergence of results may be related to disease severity rather than technological limitations. During resuscitation EtCO2 can be detected by capnography more rapidly than by colorimetry. Furthermore, capnography can be currently utilized in neonatal research settings to determine the physiological dead space and ventilation inhomogeneity, and thus has potential to be beneficial to clinical care. In conclusion, novel modes of noninvasive carbon dioxide monitoring can be safely and reliably utilized in newborn infants during mechanical ventilation. Future randomized trials should aim to address which device provides the most optimal form of monitoring in different clinical contexts.

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Resistance of Colorimetric Carbon Dioxide Detectors Commonly Utilized in Neonates

Cited by 5 publications

References 16 publications

Exhaled CO₂monitoring to guide non-invasive ventilation at birth: a systematic review

Exhaled CO₂monitoring to guide non-invasive ventilation at birth: a systematic review

Paediatric exhaled CO₂detector causes leaks

Carbon dioxide monitoring in the newborn infant

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Resistance of Colorimetric Carbon Dioxide Detectors Commonly Utilized in Neonates

Cited by 5 publications

References 16 publications

Exhaled CO2monitoring to guide non-invasive ventilation at birth: a systematic review

Exhaled CO2monitoring to guide non-invasive ventilation at birth: a systematic review

Paediatric exhaled CO2detector causes leaks

Carbon dioxide monitoring in the newborn infant

Contact Info

Product

Resources

About

Exhaled CO₂monitoring to guide non-invasive ventilation at birth: a systematic review

Exhaled CO₂monitoring to guide non-invasive ventilation at birth: a systematic review

Paediatric exhaled CO₂detector causes leaks