The Use of End-tidal Carbon Dioxide Monitoring to Confirm Endotracheal Tube Placement in Adult and Paediatric Intensive Care Units in Australia and New Zealand

Abstract

The use of end-tidal carbon dioxide monitoring to assist in confirming endotracheal tube placement is currently not mandatory in intensive care units (ICUs) in Australia and New Zealand. Early detection of failed tracheal intubation is vital to optimize management and to prevent complications. Questionnaires were sent to the lead clinician/head of department of all 66 intensive care units approved for training purposes by the Joint Faculty of Intensive Care Medicine in Australia and New Zealand. The methods used to confirm correct endotracheal tube placement, the availability of end-tidal carbon dioxide monitoring and its role in confirming endotracheal tube placement in the intensive care unit were explored. Completed questionnaires were received from 61 of the 66 centres (92.4%). Wide variation in the method of confirmation of endotracheal tube position was demonstrated, with 23 (37.7%) of units using sub-optimal methods. Sixty (98.3%) of units had end-tidal carbon dioxide monitoring available. Thirty-eight (62%) units shared monitors between several beds; and 22 (36%) had one monitor per bed. End-tidal carbon dioxide monitoring was used routinely to confirm endotracheal tube placement in 42 (68.8%) units. Fifty-two respondents (83.3%) felt that end-tidal carbon dioxide monitoring was superior to other methods for confirming endotracheal tube placement in critically ill patients. Thirty-eight respondents (62.3%) thought that endtidal carbon dioxide monitoring should be mandatory to confirm tracheal intubation in the intensive care unit. If it were available, 42 respondents (68.8%) would use end-tidal carbon dioxide monitoring for confirmation of every intubation. Mandatory end-tidal carbon dioxide confirmation of endotracheal tube placement was policy in 33 (54.1%) of the intensive care units.

Correlation between minute carbon dioxide elimination and pulmonary blood flow in single‐ventricle patients after stage 1 palliation and 2‐ventricle patients with intracardiac shunts: A pilot study

“…Capnography is used to assess respiratory function in critically ill patients . Endtidal carbon dioxide tension (EtCO 2 ) is the gold standard for determining successful endotracheal intubation and is used to assess adequacy of chest compressions during cardiopulmonary resuscitation .…”

Experiences with capnography in acute care settings: A mixed-methods analysis of clinical staff

“…10-14 Despite the increasing literature base for capnography and its incorporation into national guidelines, capnography is not being utilized to its full potential. 6-9 However, it is not due to lack of it's physical presence on the unit (its adoption), but to a failure of incorporation into clinical practice (its implementation).…”

“…As demonstrated in studies of emergency departments (EDs) and intensive care units (ICUs), capnography is available in these settings, but not used to its full extent. 10-14 Although there are many factors involved in the successful adoption and implementation of new technologies, little research exists to describe how new bedside, patient-care devices are incorporated for routine use in the work environment. 15, 16 Physicians, nurses, or hospital administrators can initiate the purchasing phase of a new device.…”

Infrastructure and Organization of Adult Intensive Care Units in Resource-Limited Settings

“…No randomized controlled trials on the use of end-tidal carbon dioxide monitoring in resource-limited settings were identified. Studies from both resource-limited and resource-rich settings prove that end-tidal carbon dioxide measurement is a reliable technique to verify endotracheal tube placement and an adequate tool to monitor mechanical ventilation [163][164][165]. Although differences between arterial and end-tidal carbon dioxide values are common and vary individually [166,167], the trends over time appear helpful to guide mechanical ventilation, particularly when arterial blood gas analyzers are unavailable [168][169][170].…”