Published online November 24, 2008
PEDIATRICS Vol. 122 No. 6 December 2008, pp. e1219-e1224 (doi:10.1542/peds.2008-1300)
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ARTICLE

A Novel Method of Distal End-Tidal CO2 Capnography in Intubated Infants: Comparison With Arterial CO2 and With Proximal Mainstream End-Tidal CO2

Amir Kugelman, MDa,b, Dana Zeiger-Aginsky, MDa, David Bader, MD, MHAa, Irit Shoris, RNa and Arieh Riskin, MDa

a Department of Neonatology
b Pediatric Pulmonary Unit, Bnai-Zion Medical Center, Bruce Rappaport Faculty of Medicine, Haifa, Israel

OBJECTIVE. The objective of this study was to evaluate a novel method of distal end-tidal CO2 capnography by comparison with PaCO2 and with the more standard method that measures mainstream proximal end-tidal CO2 in intubated infants.

METHODS. Included in the study were all infants who were ventilated with conventional mechanical ventilation and intubated with a double-lumen endotracheal tube in our NICU during the study period. Data were collected prospectively from 2 capnographs simultaneously and compared with PaCO2. Sidestream distal end-tidal CO2 was measured by a Microstream capnograph via the extra port of a double-lumen endotracheal tube. Mainstream proximal end-tidal CO2 was measured via capnograph connected to the endotracheal tube.

RESULTS. Twenty-seven infants (median [range] birth-weight: 1835 [490–4790] g; gestational age: 32.5 [24.8–40.8] weeks) participated in the study. We used for analysis 222 and 212 measurements of distal end-tidal CO2 and proximal end-tidal CO2, respectively. Distal compared with proximal end-tidal CO2 had a better correlation with PaCO2 and a better agreement with PaCO2. The accuracy of distal end-tidal CO2 decreased, but it remained a useful measure of PaCO2 in the high range of PaCO2 (≥60 mmHg) or in conditions of severe lung disease. A subanalysis for infants who weighed <1500 g (13 infants, 84 observations) revealed a good correlation and agreement between distal end-tidal CO2 and PaCO2 and poor correlation and agreement for proximal end-tidal CO2.

CONCLUSIONS. Distal end-tidal CO2 measured via a double-lumen endotracheal tube was found to have good correlation and agreement with PaCO2, remained reliable in conditions of severe lung disease, and was more accurate than the standard mainstream proximal end-tidal CO2.

Key Words: end-tidal carbon dioxide • mainstream ETCO2 • Microstream technique • preterm infants • sidestream ETCO2

Abbreviations: ETCO2—end-tidal CO2 • ETT—endotracheal tube • DETCO2—distal end-tidal CO2 • PETCO2—proximal end-tidal CO2 • OI—oxygenation index • PACO2—partial pressure of CO2 in the alveoli • VLBW—very low birth weight • PaO2/PAO2 ratio—arterial to alveolar oxygen tension ratio

Accepted Aug 7, 2008.


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