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Stratton M, Overmann K, Zhang Y, Ruddy R. Bias between capnometry and venous carbon dioxide during initial assessment of pediatric emergency department patients: A video-based study. J Am Coll Emerg Physicians Open 2024; 5:e13170. [PMID: 38680203 PMCID: PMC11046081 DOI: 10.1002/emp2.13170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 05/01/2024] Open
Abstract
Objective The bias of capnometry (ETCO2) and venous carbon dioxide (vpCO2) among pediatric emergency department (PED) patients triaged to critical care areas is unknown. We aimed to explore correlations and bias between ETCO2 and vpCO2¸and identify predictors of bias. Methods This was an observational, video-based, retrospective study comparing ETCO2 and vpCO2. Pediatric patients with simultaneous ETCO2 and vpCO2 data were included. Our primary aim utilized linear regressions to determine correlations and Bland-Altman analysis to assess bias. Our secondary aim utilized multiple regression to identify clinical covariates contributing to bias. Covariates included age, respiratory rate, heart rate, mean arterial blood pressure, capnometry interface, PED diagnosis, and PED disposition. Results A total of 200 PED patients with ETCO2 and vpCO2 data were included. The median (interquartile range [IQR]) ETCO2, vpCO2, and ΔCO2 in mmHg were 38 (32, 46), 49 (41, 61), and 11 (4, 20), respectively. ETCO2 (r = 0.76) and ΔCO2 (r = 0.71) were highly correlated with vpCO2. The mean bias between ETCO2 and vpCO2 was -14.1 mmHg (95% confidence interval [CI], -41.9 -13.7). The bias between ETCO2 and vpCO2 increased at higher values of each measure. ETCO2 sampling interface was the only independent predictor of vpCO2 in our multivariate analysis. Patients requiring bag-valve mask (BVM) ventilation had the highest median bias between ETCO2 and vpCO2 (29 mmHg, IQR 15, 37). Conclusion ETCO2 and vpCO2 were highly correlated. However, bias increased at higher levels of both ETCO2 and vpCO2. Among PED patients, ETCO2's ability to approximate vpCO2 diminishes with worsening hypercarbic respiratory failure.
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Affiliation(s)
- Michael Stratton
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Kevin Overmann
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Yin Zhang
- Division of Biostatistics and EpidemiologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Richard Ruddy
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
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Kirbas Cilingir E, Besbinar O, Giro L, Bartoli M, Hueso JL, Mintz KJ, Aydogan Y, Garber JM, Turktas M, Ekim O, Ceylan A, Unal MA, Ensoy M, Arı F, Ozgenç Çinar O, Ozturk BI, Gokce C, Cansaran-Duman D, Braun M, Wachtveitl J, Santamaria J, Delogu LG, Tagliaferro A, Yilmazer A, Leblanc RM. Small Warriors of Nature: Novel Red Emissive Chlorophyllin Carbon Dots Harnessing Fenton-Fueled Ferroptosis for In Vitro and In Vivo Cancer Treatment. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2309283. [PMID: 38230862 DOI: 10.1002/smll.202309283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/11/2023] [Indexed: 01/18/2024]
Abstract
The appeal of carbon dots (CDs) has grown recently, due to their established biocompatibility, adjustable photoluminescence properties, and excellent water solubility. For the first time in the literature, copper chlorophyllin-based carbon dots (Chl-D CDs) are successfully synthesized. Chl-D CDs exhibit unique spectroscopic traits and are found to induce a Fenton-like reaction, augmenting photodynamic therapy (PDT) efficacies via ferroptotic and apoptotic pathways. To bolster the therapeutic impact of Chl-D CDs, a widely used cancer drug, temozolomide, is linked to their surface, yielding a synergistic effect with PDT and chemotherapy. Chl-D CDs' biocompatibility in immune cells and in vivo models showed great clinical potential.Proteomic analysis was conducted to understand Chl-D CDs' underlying cancer treatment mechanism. The study underscores the role of reactive oxygen species formation and pointed toward various oxidative stress modulators like aldolase A (ALDOA), aldolase C (ALDOC), aldehyde dehydrogenase 1B1 (ALDH1B1), transaldolase 1 (TALDO1), and transketolase (TKT), offering a deeper understanding of the Chl-D CDs' anticancer activity. Notably, the Chl-D CDs' capacity to trigger a Fenton-like reaction leads to enhanced PDT efficiencies through ferroptotic and apoptotic pathways. Hence, it is firmly believed that the inherent attributes of Chl-CDs can lead to a secure and efficient combined cancer therapy.
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Affiliation(s)
- Emel Kirbas Cilingir
- Department of Chemistry, University of Miami, 1301 Memorial Drive, Coral Gables, FL, 33146, USA
| | - Omur Besbinar
- Department of Biomedical Engineering, Faculty of Engineering, Ankara University, Ankara, 06830, Turkey
- Stem Cell Institute, Ankara University, Ankara, 06520, Turkey
- The Graduate School of Health Sciences of Ankara University, Ankara, 06110, Turkey
- Institute of Nanoscience and Materials of Aragon (INMA), CSIC-Universidad de Zaragoza, Campus Río Ebro, Edificio I+D, C/Poeta Mariano Esquillor, s/n, Zaragoza, 50018, Spain
| | - Linda Giro
- Department of Biomedical Sciences, University of Padua, Padua, 35129, Italy
| | - Mattia Bartoli
- Department of Applied Science and Technology, Politecnico di Torino, Torino, 10129, Italy
| | - Jose L Hueso
- Institute of Nanoscience and Materials of Aragon (INMA), CSIC-Universidad de Zaragoza, Campus Río Ebro, Edificio I+D, C/Poeta Mariano Esquillor, s/n, Zaragoza, 50018, Spain
- Networking Research Center in Biomaterials, Bioengineering and Nanomedicine (CIBER-BBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Department of Chemical and Environmental Engineering, University of Zaragoza, Campus Rio Ebro, C/María de Luna, 3, Zaragoza, 50018, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Avenida San Juan Bosco, 13, Zaragoza, 50009, Spain
| | - Keenan J Mintz
- Department of Chemistry, University of Miami, 1301 Memorial Drive, Coral Gables, FL, 33146, USA
| | - Yagmur Aydogan
- Institute of Physical and Theoretical Chemistry, Goethe University Frankfurt, 60438, Frankfurt, Germany
| | - Jordan M Garber
- Department of Chemistry, University of Miami, 1301 Memorial Drive, Coral Gables, FL, 33146, USA
| | - Mine Turktas
- Department of Biology, Faculty of Science, Gazi University, Ankara, 06560, Turkey
| | - Okan Ekim
- Department of Anatomy, Faculty of Veterinary Medicine, Ankara University, Ankara, 06110, Turkey
| | - Ahmet Ceylan
- Department of Histology Embryology, Faculty of Veterinary Medicine, Ankara University, Ankara, 06110, Turkey
| | | | - Mine Ensoy
- Biotechnology Institute, Ankara University, Ankara, 06135, Turkey
| | - Fikret Arı
- Department of Electrical Electronic Engineering, Faculty of Engineering, Ankara, 06830, Turkey
| | - Ozge Ozgenç Çinar
- Department of Histology Embryology, Faculty of Veterinary Medicine, Ankara University, Ankara, 06110, Turkey
| | - Berfin Ilayda Ozturk
- Department of Biomedical Engineering, Faculty of Engineering, Ankara University, Ankara, 06830, Turkey
| | - Cemile Gokce
- Department of Biomedical Engineering, Faculty of Engineering, Ankara University, Ankara, 06830, Turkey
| | | | - Markus Braun
- Institute of Physical and Theoretical Chemistry, Goethe University Frankfurt, 60438, Frankfurt, Germany
| | - Josef Wachtveitl
- Institute of Physical and Theoretical Chemistry, Goethe University Frankfurt, 60438, Frankfurt, Germany
| | - Jesus Santamaria
- Institute of Nanoscience and Materials of Aragon (INMA), CSIC-Universidad de Zaragoza, Campus Río Ebro, Edificio I+D, C/Poeta Mariano Esquillor, s/n, Zaragoza, 50018, Spain
- Networking Research Center in Biomaterials, Bioengineering and Nanomedicine (CIBER-BBN), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Department of Chemical and Environmental Engineering, University of Zaragoza, Campus Rio Ebro, C/María de Luna, 3, Zaragoza, 50018, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Avenida San Juan Bosco, 13, Zaragoza, 50009, Spain
| | - Lucia Gemma Delogu
- Department of Biomedical Sciences, University of Padua, Padua, 35129, Italy
- Department of Biology, College of Arts and Sciences, Khalifa University, Abu Dhabi, 127788, UAE
| | - Alberto Tagliaferro
- Department of Applied Science and Technology, Politecnico di Torino, Torino, 10129, Italy
| | - Açelya Yilmazer
- Department of Biomedical Engineering, Faculty of Engineering, Ankara University, Ankara, 06830, Turkey
- Stem Cell Institute, Ankara University, Ankara, 06520, Turkey
| | - Roger M Leblanc
- Department of Chemistry, University of Miami, 1301 Memorial Drive, Coral Gables, FL, 33146, USA
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Borenstein-Levin L, Avishay N, Soffer O, Arnon S, Riskin A, Dinur G, Lavie-Nevo K, Gover A, Kugelman A, Hochwald O. Transcutaneous CO 2 Monitoring in Extremely Low Birth Weight Premature Infants. J Clin Med 2023; 12:5757. [PMID: 37685823 PMCID: PMC10488371 DOI: 10.3390/jcm12175757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Extremely low birth weight (ELBW) premature infants are particularly susceptible to hypocarbia and hypercarbia, which are associated with brain and lung morbidities. Transcutaneous CO2 (TcCO2) monitoring allows for continuous non-invasive CO2 monitoring during invasive and non-invasive ventilation and is becoming more popular in the NICU. We aimed to evaluate the correlation and agreement between CO2 levels measured by a TcCO2 monitor and blood gas CO2 (bgCO2) among ELBW infants. This was a prospective observational multicenter study. All infants < 1000 g admitted to the participating NICUs during the study period were monitored by a TcCO2 monitor, if available. For each bgCO2 measured, a simultaneous TcCO2 measurement was documented. In total, 1828 pairs of TcCO2-bgCO2 values of 94 infants were collected, with a median (IQR) gestational age of 26.4 (26.0, 28.3) weeks and birth weight of 800 (702, 900) g. A moderate correlation (Pearson: r = 0.64) and good agreement (bias (95% limits of agreement)):(2.9 [-11.8, 17.6] mmHg) were found between the TcCO2 and bgCO2 values in the 25-70 mmHg TcCO2 range. The correlation between the TcCO2 and bgCO2 trends was moderate. CO2 measurements by TcCO2 are in good agreement (bias < 5 mmHg) with bgCO2 among premature infants < 1000 g during the first week of life, regardless of day of life, ventilation mode (invasive/non-invasive), and sampling method (arterial/capillary/venous). However, wide limits of agreement and moderate correlation dictate the use of TcCO2 as a complementary tool to blood gas sampling, to assess CO2 levels and trends in individual patients.
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Affiliation(s)
- Liron Borenstein-Levin
- Department of Neonatology, Rambam Health Care Campus, Haifa 3109601, Israel; (O.S.); (G.D.); (A.K.); (O.H.)
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel; (N.A.); (A.R.); (K.L.-N.); (A.G.)
| | - Noa Avishay
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel; (N.A.); (A.R.); (K.L.-N.); (A.G.)
| | - Orit Soffer
- Department of Neonatology, Rambam Health Care Campus, Haifa 3109601, Israel; (O.S.); (G.D.); (A.K.); (O.H.)
| | - Shmuel Arnon
- Department of Neonatology, Meir Medical Center, Kfar-Saba 4428164b, Israel;
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Arieh Riskin
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel; (N.A.); (A.R.); (K.L.-N.); (A.G.)
- Department of Neonatology, Bnai Zion Medical Center, Haifa 32000, Israel
| | - Gil Dinur
- Department of Neonatology, Rambam Health Care Campus, Haifa 3109601, Israel; (O.S.); (G.D.); (A.K.); (O.H.)
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel; (N.A.); (A.R.); (K.L.-N.); (A.G.)
| | - Karen Lavie-Nevo
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel; (N.A.); (A.R.); (K.L.-N.); (A.G.)
- Department of Neonatology, Carmel Medical Center, Haifa 3436212, Israel
| | - Ayala Gover
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel; (N.A.); (A.R.); (K.L.-N.); (A.G.)
- Department of Neonatology, Carmel Medical Center, Haifa 3436212, Israel
| | - Amir Kugelman
- Department of Neonatology, Rambam Health Care Campus, Haifa 3109601, Israel; (O.S.); (G.D.); (A.K.); (O.H.)
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel; (N.A.); (A.R.); (K.L.-N.); (A.G.)
| | - Ori Hochwald
- Department of Neonatology, Rambam Health Care Campus, Haifa 3109601, Israel; (O.S.); (G.D.); (A.K.); (O.H.)
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel; (N.A.); (A.R.); (K.L.-N.); (A.G.)
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Fucikova H, Blatny J, Stingl J, Miletin J. Capnometry during neonatal transport-Mini review. Acta Paediatr 2023; 112:919-923. [PMID: 36843232 DOI: 10.1111/apa.16729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/15/2023] [Accepted: 02/23/2023] [Indexed: 02/28/2023]
Abstract
AIM The aim of this review was to give an overview of available data on end-tidal CO2 (etCO2 ) monitoring, also called capnometry, during neonatal transport. METHODS Pubmed/MEDLINE database was searched using research question (capno* OR etCO2 OR detCO2 OR (['end tidal' OR 'end-tidal'] AND [CO2 OR 'carbon dioxide']) AND (neonat* OR infant* OR newborn*) AND transport*). All articles relevant to the topic were reviewed and summarised. RESULTS The lack of studies relevant to neonatal transport prompted us to extend the search to capnometry in a neonatal intensive care setting. The published studies are showing conflicting results. The different study populations, technologies used to measure etCO2 , types of etCO2 sampling and the diverse sites of blood gas tests make the data unsuitable for systematic comparison. CONCLUSION Further research to obtain more data on capnometry during neonatal transport will be necessary to define precisely under what circumstances can end-tidal monitoring of CO2 be reliably used in neonates during transport and also how to interpret the measured values.
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Affiliation(s)
- Hana Fucikova
- Coombe Women and Infants University Hospital, Dublin, Ireland
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Blatny
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Children's University Hospital, Brno, Czech Republic
| | - Jan Stingl
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Miletin
- Coombe Women and Infants University Hospital, Dublin, Ireland
- Institute for the Care of Mother and Child, Prague, Czech Republic
- UCD School of Medicine, University College Dublin, Dublin, Ireland
- Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Pelchat J, Desprez I, Beaufrère H, Beazley SG, Duke-Novakovski T. Comparison between mainstream (Capnostat 5) and a low-flow sidestream capnometer (Capnostream) in mechanically ventilated, sevoflurane-anesthetized rabbits using a Bain coaxial delivery system. Vet Anaesth Analg 2023; 50:81-90. [PMID: 36517354 DOI: 10.1016/j.vaa.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/11/2022] [Accepted: 11/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate agreement between end-tidal carbon dioxide (Pe'CO2) and PaCO2 with sidestream and mainstream capnometers in mechanically ventilated anesthetized rabbits, with two ventilatory strategies. STUDY DESIGN Prospective experimental study. ANIMALS A total of 10 New Zealand White rabbits weighing 3.6 ± 0.3 kg (mean ± standard deviation). METHODS Rabbits anesthetized with sevoflurane were intubated with an uncuffed endotracheal tube (3.0 mm internal diameter) and adequate seal. For Pe'CO2, the sidestream capnometer sampling adapter or the mainstream capnometer was placed between the endotracheal tube and Bain breathing system (1.5 L minute-1 oxygen). PaCO2 was obtained from arterial blood collected every 5 minutes. A time-cycled ventilator delivered an inspiratory time of 1 second and 12 or 20 breaths minute-1. Peak inspiratory pressure was initially set to achieve Pe'CO2 normocapnia of 35-45 mmHg (4.6-6.0 kPa). A total of five paired Pe'CO2 and PaCO2 measurements were obtained with each ventilation mode for each capnometer. Anesthetic episodes were separated by 7 days. Agreement was assessed using Bland-Altman analysis and linear mixed models; p < 0.05. RESULTS There were 90 and 83 pairs for the mainstream and sidestream capnometers, respectively. The mainstream capnometer underestimated PaCO2 by 12.6 ± 2.9 mmHg (proportional bias 0.44 ± 0.06 mmHg per 1 mmHg PaCO2 increase). With the sidestream capnometer, ventilation mode had a significant effect on Pe'CO2. At 12 breaths minute-1, Pe'CO2 underestimated PaCO2 by 23.9 ± 8.2 mmHg (proportional bias: 0.81 ± 0.18 mmHg per 1 mmHg PaCO2 increase). At 20 breaths minute-1, Pe'CO2 underestimated PaCO2 by 38.8 ± 5.0 mmHg (proportional bias 1.13 ± 0.10 mmHg per 1 mmHg PaCO2 increase). CONCLUSIONS AND CLINICAL RELEVANCE Both capnometers underestimated PaCO2. The sidestream capnometer underestimated PaCO2 more than the mainstream capnometer, and was affected by ventilation mode.
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Affiliation(s)
- Jennifer Pelchat
- Department of Small Animal Clinical Studies, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Isabelle Desprez
- Department of Small Animal Clinical Studies, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Hugues Beaufrère
- Department of Veterinary Medicine and Epidemiology, University of California Davis School of Veterinary Medicine, Davis, CA, USA
| | - Shannon G Beazley
- Department of Small Animal Clinical Studies, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Tanya Duke-Novakovski
- Department of Small Animal Clinical Studies, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Capnography in newborns under mechanical ventilation and its relationship with the measurement of CO 2 in blood samples. An Pediatr (Barc) 2022; 97:255-261. [PMID: 36109326 DOI: 10.1016/j.anpede.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/15/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Monitoring the partial pressure of CO2 (PCO2) in newborns who require ventilation would allow avoiding hypocapnia and hypercapnia. The measurement of end-tidal carbon dioxide (ETCO2) is an alternative rarely implemented in this population. OBJECTIVE To evaluate the relationship between ETCO2 and PCO2 in newborns. METHODS Cross-sectional study comparing two PCO2 measurement methods, the conventional one by analysis of blood samples and the one estimated by ETCO2. The study included hospitalized newborns that required conventional mechanical ventilation. The ETCO2 was measured with a Tecme GraphNet® neo, a neonatal ventilator with an integrated capnograph, and we obtained the ETCO2-PCO2 gradient. We conducted correlation and Bland-Altman plot analyses to estimate the agreement. RESULTS A total of 277 samples (ETCO2 / PCO2) from 83 newborns were analyzed. The mean values of ETCO2 and PCO2 were 41.36mmHg and 42.04mmHg. There was a positive and significant correlation between ETCO2 and PCO2 in the overall analysis (r=0.5402; P<.001) and in the analysis of each unit (P<.001). The mean difference was 0.68 mmHg (95% CI, -0.68 to 1.95) and was not significant. We observed a positive systematic error (PCO2 > ETCO2) in 2 of the units, and a negative difference in the third (PCO2 < ETCO2). DISCUSSION The correlation between ETCO and PCO2 was significant, although the obtained values were not equivalent, with differences ranging from 0.1mmHg and 20mmHg. Likewise, we found systematic errors that differed in sign (positive or negative) between institutions.
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Sosa I, Cardetti M, Favareto V, Maure C, Ceballos E, Abona H, Martínez F, Gigli M, Rodríguez S, Sola A. Capnografía en recién nacidos en ventilación mecánica y su relación con la medición de CO2 en muestras sanguíneas. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Williams E, Bednarczuk N, Dassios T, Greenough A. Factors affecting the arterial to end-tidal carbon dioxide gradient in ventilated neonates. Physiol Meas 2022; 43. [PMID: 35196261 DOI: 10.1088/1361-6579/ac57ca] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/23/2022] [Indexed: 11/11/2022]
Abstract
Objective. To determine factors which influenced the relationship between blood carbon dioxide (pCO2) and end-tidal carbon dioxide (EtCO2) values in ventilated, newborn infants. Furthermore, to assess whether pCO2levels could be predicted from continuous EtCO2monitoring.Approach. An observational study of routinely monitored newborn infants requiring mechanical ventilation in the first 28 d after birth was undertaken. Infants received standard clinical care. Daily pCO2and EtCO2levels were recorded and the difference (gradient: ∆P-EtCO2) between the pairs were calculated. Ventilatory settings corresponding to the time of each blood gas assessment were noted. End-tidal capnography monitoring was performed using the Microstream sidestream Filterline H set capnograph.Main results. A total of 4697 blood gas results from one hundred and fifty infants were analysed. The infants had a median gestational age of 33.3 (range 22.3-42.0) weeks and birth weight of 1880 (395-5520) grams. Overall, there was moderate correlation between pCO2and EtCO2levels (r= 0.65,p< 0.001). The ∆P-EtCO2for infants born less than 32 weeks of gestation was significantly higher (1.4 kPa) compared to infants born at greater than 32 weeks of gestation (0.8 kPa) (p< 0.001). In infants born at less than 32 completed weeks of gestation, pCO2levels were independently associated with EtCO2, day after birth, birthweight and fraction of inspired oxygen (FiO2) (modelr2 = 0.52,p< 0.001).Significance. The results of end-tidal capnography monitoring have the potential to predict blood carbon dioxide values within the neonatal population.
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Affiliation(s)
- Emma Williams
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom
| | - Nadja Bednarczuk
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom
| | - Theodore Dassios
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom.,Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom.,Asthma UK Centre for Allergic Mechanisms, King's College London, United Kingdom.,NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, United Kingdom
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Williams E, Dassios T, Greenough A. Carbon dioxide monitoring in the newborn infant. Pediatr Pulmonol 2021; 56:3148-3156. [PMID: 34365738 DOI: 10.1002/ppul.25605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Emma Williams
- Department of Woman and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Theodore Dassios
- Department of Woman and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Anne Greenough
- Department of Woman and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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Williams E, Dassios T, O'Reilly N, Walsh A, Greenough A. End-tidal capnography monitoring in infants ventilated on the neonatal intensive care unit. J Perinatol 2021; 41:1718-1724. [PMID: 33649438 PMCID: PMC7917950 DOI: 10.1038/s41372-021-00978-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/22/2020] [Accepted: 01/28/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess whether end-tidal capnography (EtCO2) monitoring reduced the magnitude of difference in carbon dioxide (CO2) levels and the number of blood gases in ventilated infants. STUDY DESIGN A case-control study of a prospective cohort (n = 36) with capnography monitoring and matched historical controls (n = 36). RESULT The infants had a median gestational age of 31.6 weeks. A reduction in the highest CO2 level on day 1 after birth was observed after the introduction of EtCO2 monitoring (p = 0.043). There was also a reduction in the magnitude of difference in CO2 levels on days 1 (p = 0.002) and 4 (p = 0.049) after birth. There was no significant difference in the number of blood gases. CONCLUSION Continuous end-tidal capnography monitoring in ventilated infants was associated with a reduction in the degree of the magnitude of difference in CO2 levels and highest level of CO2 on the first day after birth.
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Affiliation(s)
- Emma Williams
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- The Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK
| | - Theodore Dassios
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Niamh O'Reilly
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alison Walsh
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
- The Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK.
- NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
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11
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Martins IPM, Nakato AM, Hembecker PK, Ioshii SO, Nohama P. Correlation of End-Tidal Carbon Dioxide with Arterial Carbon Dioxide in Mechanically Ventilated Neonates: A Scoping Review. Glob Pediatr Health 2021; 8:2333794X211016790. [PMID: 34036124 PMCID: PMC8132087 DOI: 10.1177/2333794x211016790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/21/2021] [Indexed: 12/03/2022] Open
Abstract
Monitoring CO2 levels in intubated neonates is highly relevant in the face of complications associated with altered CO2 levels. Thus, this review aims to present the scientific evidence in the literature regarding the correlation between arterial carbon dioxide measured by non-invasive methods in newborns submitted to invasive mechanical ventilation. The search was carried out from January 2020 to January 2021, in the Scopus, Medline, The Cochrane Library, Web of Science, CINAHL and Embase databases. Also, a manual search of the references of included studies was performed. The main descriptors used were: "capnography," "premature infant," "blood gas analysis," and "mechanical ventilation." As a result, 221 articles were identified, and 18 were included in this review. A total of 789 newborns were evaluated, with gestational age between 22.8 and 42.2 weeks and birth weight between 332 and 4790 g. Capnometry was the most widely used non-invasive method. In general, the correlation and agreement between the methods evaluated in the studies were strong/high. The birth weight did not influence the results. The gestational age of fewer than 37 weeks implied, in its majority, a moderate correlation and agreement. Therefore, we can conclude that there was a predominance of a strong correlation between arterial blood gases and non-invasive methods, although there are variations found in the literature. Even so, the results were promising and may provide valuable data for future studies, which are necessary to consolidate non-invasive methods as a reliable and viable alternative to arterial blood gasometry.
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Affiliation(s)
| | - Adriane Muller Nakato
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Paula Karina Hembecker
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Sérgio Ossamu Ioshii
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Percy Nohama
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
- Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal do Paraná, Curitiba, Paraná, Brazil
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12
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Uzunay H, Selvi F, Bedel C, Karakoyun OF. Comparison of ETCO2 Value and Blood Gas PCO2 Value of Patients Receiving Non-invasive Mechanical Ventilation Treatment in Emergency Department. ACTA ACUST UNITED AC 2021; 3:1717-1721. [PMID: 33937634 PMCID: PMC8078828 DOI: 10.1007/s42399-021-00935-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 11/01/2022]
Abstract
Capnography is the non-invasive measurement and graphic representation of the partial pressure of CO2 in expiration. Although there are many studies in the literature comparing the partial pressure of carbon dioxide (pCO2) and end-tidal CO2 (ETCO2) values in patients who underwent IMV (invasive mechanical ventilation), there are no studies showing their interchangeable applicability in patients who received NIMV (non-IMV). We aimed to evaluate whether the use of ETCO2 in the treatment process can replace pCO2 use in patients scheduled for NIMV treatment in the emergency department. Patients who applied to the emergency department with respiratory distress between March 2019 and January 2020, who were diagnosed with acute cardiogenic edema or acute chronic obstructive pulmonary disease (COPD) exacerbation, and who needed NIMV were included in the study. General characteristics of the patients and the pCO2 and ETCO2 values were measured in the blood gas 1 h after the NIMV application was started. 64.2% (99 patients) of the patients included in the study were male, and 35.8% (55 patients) were female. The mean age of the patients included in the study was 69.1 ± 12.2 years. The mean pCO2 values were measured as 52.6 ± 13.2. The mean of ETCO2 values measured simultaneously was 33.6 ± 10.1. There was a significant difference between the controlled pCO2 values and ETCO2 values at the first hour of NIMV treatment (Z: - 10.640, p < 0.001). The ETCO2 level was found to be different in our patients who received NIMV treatment, which could not be used instead of the pCO2 level.
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Affiliation(s)
- Hüseyin Uzunay
- Department of Emergency Medicine, Kas State Hospital, Antalya, Turkey
| | - Fatih Selvi
- Department of Emergency Medicine, Health Science University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Cihan Bedel
- Department of Emergency Medicine, Health Science University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Omer Faruk Karakoyun
- Department of Emergency Medicine, Mugla Sitki Kocman University Training Research Hospital, Mugla, Turkey
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Accuracy of a battery-powered portable capnometer in premature infants. J Clin Monit Comput 2021; 36:209-213. [PMID: 33385261 PMCID: PMC7775636 DOI: 10.1007/s10877-020-00638-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/17/2020] [Indexed: 11/25/2022]
Abstract
Carbon dioxide measurement is useful for confirmation of successful tracheal intubation and ensuring adequate ventilation. There are two types of CO2 detectors, i.e., single-use-only colorimetric devices and capnometers. Although portable capnometers are widely used for resuscitation, there have been no reports regarding their clinical utility in neonates. The correspondence between end-tidal CO2 (PetCO2) level determined using a battery-powered portable capnometer and arterial CO2 (PaCO2) was investigated using paired data obtained simultaneously from 26 neonates weighing 1262 ± 589 g at examination on mechanical ventilation. PetCO2 level and PaCO2 showed a strong correlation (r = 0.839, P < 0.001), and the correlation equation was: PetCO2 = 0.8 × PaCO2 + 1.1. Therefore, PetCO2 readings obtained with a battery-powered portable capnometer were likely to be underestimated. This became more pronounced with decreasing infant body weight at examination as the net difference in measurements of PaCO2 and PetCO2 was significantly positively correlated with infant body weight at examination (r = 0.451, P < 0.001). The observations presented here may be helpful in the use of battery-powered portable capnometers in neonates requiring controlled ventilation with tracheal intubation.
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Comparing the novel microstream and the traditional mainstream method of end-tidal CO 2 monitoring with respect to PaCO 2 as gold standard in intubated critically ill children. Sci Rep 2020; 10:22042. [PMID: 33328527 PMCID: PMC7744570 DOI: 10.1038/s41598-020-79054-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023] Open
Abstract
The objective of this study was to evaluate a novel microstream method by comparison with PaCO2 and the more standard mainstream capnometer in intubated pediatric patients. We hypothesized that the novel microstream method would superior compared to the traditional mainstream method in predicting PaCO2. This was a prospective single-center comparative study. The study was carried out on 174 subjects with a total of 1338 values for each method. Data were collected prospectively from mainstream and microstream capnometer simultaneously and compared with PaCO2 results. Although both mainstream PetCO2 (mainPetCO2) and microstream PetCO2 (microPetCO2) were moderately correlated (r = 0.63 and r = 0.68, respectively) with PaCO2 values, mainPetCO2 was in better agreement with PaCO2 in all subjects (bias ± precision values of 3.8 ± 8.9 and 7.3 ± 8.2 mmHg, respectively). In those with severe pulmonary disease, the mainPetCO2 and microPetCO2 methods were highly correlated with PaCO2 (r = 0.80 and r = 0.81, respectively); however, the biases of both methods increased (14.8 ± 9.1 mmHg and 16.2 ± 9.0 mmHg, respectively). In cases with increased physiologic dead space ventilation, the agreement levels of mainPetCO2 and microPetCO2 methods became distorted (bias ± precision values of 20.9 ± 11.2 and 25.0 ± 11.8 mm Hg, respectively) even though mainPetCO2 and microPetCO2 were highly correlated (r = 0.78 and r = 0.78, respectively). It was found that the novel microstream capnometer method for PetCO2 measurements provided no superiority to the traditional mainstream method. Both capnometer methods may be useful in predicting the trend of PaCO2 due to significant correlations with the gold standard measurement in cases with severe pulmonary disease or increased physiological dead space –despite reduced accuracy.
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15
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Williams E, Dassios T, Greenough A. Assessment of sidestream end-tidal capnography in ventilated infants on the neonatal unit. Pediatr Pulmonol 2020; 55:1468-1473. [PMID: 32187888 DOI: 10.1002/ppul.24738] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/11/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Continuous monitoring of carbon dioxide (CO2 ) levels can be achieved by capnography. Our aims were to compare the performance of a sidestream capnograph with a low dead space and sampling rate to a mainstream device and evaluate whether its results correlated with arterial/capillary CO2 levels in infants with different respiratory disease severities. WORKING HYPOTHESES End-tidal carbon dioxide (EtCO2 ) results by sidestream and mainstream capnography would correlate, but the divergence of EtCO2 and CO2 results would occur in more severe lung disease. STUDY DESIGN Prospective cohort study. PATIENT-SUBJECT SELECTION Fifty infants with a median (interquartile range) gestational age of 31.1 (27.1-37.4) weeks and birth weight of 1.37 (0.76-2.95) kg. METHODOLOGY Concurrent measurements of EtCO2 in ventilated infants were made using a new Microstream sidestream device and a mainstream capnograph (gold standard). Results from both devices were compared with arterial or capillary CO2 levels. The ratio of dead space to tidal volume (Vd/Vt) was calculated to assess respiratory disease severity. RESULTS The mean difference between the concurrent measurements of EtCO2 was -0.54 ± 0.67 kPa (95% agreement levels - 1.86 to 0.77 kPa), the correlation between the two was r = .85 (P < .001). Sidestream capnography results correlated better with partial pressure of CO2 (PCO2 ) levels in infants with less (Vd/Vt < 0.35; r2 = .66, P < .001) rather than more severe (Vd/Vt > 0.35; r2 = .33, P = .01) lung disease. CONCLUSIONS The sidestream capnography performed similarly to the mainstream capnography. The poorer correlation of EtCO2 to PCO2 levels in infants with severe respiratory disease should highlight to clinicians increased ventilation-perfusion mismatch.
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Affiliation(s)
- Emma Williams
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,The Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK
| | - Theodore Dassios
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,The Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK.,NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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16
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McCann ME, Lee JK, Inder T. Beyond Anesthesia Toxicity: Anesthetic Considerations to Lessen the Risk of Neonatal Neurological Injury. Anesth Analg 2020; 129:1354-1364. [PMID: 31517675 DOI: 10.1213/ane.0000000000004271] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Infants who undergo surgical procedures in the first few months of life are at a higher risk of death or subsequent neurodevelopmental abnormalities. Although the pathogenesis of these outcomes is multifactorial, an understanding of the nature and pathogenesis of brain injury in these infants may assist the anesthesiologist in consideration of their day-to-day practice to minimize such risks. This review will summarize the main types of brain injury in preterm and term infants and their key pathways. In addition, the review will address key potential pathogenic pathways that may be modifiable including intraoperative hypotension, hypocapnia, hyperoxia or hypoxia, hypoglycemia, and hyperthermia. Each of these conditions may increase the risk of perioperative neurological injury, but their long-term ramifications are unclear.
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Affiliation(s)
- Mary Ellen McCann
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jennifer K Lee
- Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology, Johns Hopkins University, Baltimore, Maryland
| | - Terrie Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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17
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Duke-Novakovski T, Fujiyama M, Beazley SG. Comparison of mainstream (Capnostat 5) and two low-flow sidestream capnometers (VM-2500-S and Capnostream) in spontaneously breathing rabbits anesthetized with a Bain coaxial breathing system. Vet Anaesth Analg 2020; 47:537-546. [PMID: 32381351 DOI: 10.1016/j.vaa.2020.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate agreement with PaCO2 of two low sampling rate sidestream capnometers and a mainstream capnometer in rabbits and the effect of using high fresh gas flow from a Bain coaxial breathing system. STUDY DESIGN Prospective, crossover study. ANIMALS A total of 10 New Zealand White rabbits weighing 3.4 ± 0.3 kg [mean ± standard deviation (SD)]. METHODS Two sidestream analyzers (Viamed VM-2500-S and Capnostream 35) with a sampling rate of 50 mL minute-1 and a mainstream capnometer (Capnostat 5) were tested. All capnometers used infrared spectroscopy and advanced microprocessor technology. Rabbits were anesthetized and intubated with noncuffed endotracheal tubes of 3 mm internal diameter and adequate seal. A sidestream sampling adapter or the mainstream capnometer was attached to the endotracheal tube and connected to a Bain coaxial breathing system. Oxygen (1.5 L minute-1) delivered sevoflurane to maintain anesthesia. An auricular artery catheter allowed blood sampling for PaCO2 analysis corrected to rectal temperature. Inspired and end-tidal carbon dioxide (Pe'CO2) measurements were recorded during blood sample withdrawal. From each rabbit, 10 paired PaCO2/Pe'CO2 measurements were obtained. Each rabbit was recovered from anesthesia and was anesthetized again with an alternate capnometer after 1 week. Data were analyzed using Bland-Altman and two-way anova for repeated measures. RESULTS Analysis included 100 paired samples. Negative bias reflects underestimation of PaCO2. Bland-Altman mean (±1.95 SD) was -16.7 (-35.2 to 1.8) mmHg for Capnostat 5, -27.9 (-48.6 to -7.2) mmHg for Viamed, and -18.1 (-34.3 to -1.9) mmHg for Capnostream. Viamed PaCO2-Pe'CO2 gradient was greater than other two capnometers. CONCLUSIONS All three capnometers underestimated PaCO2. Capnostat 5 and Capnostream performed similarly. CLINICAL RELEVANCE These capnometers underestimated PaCO2 in spontaneously breathing rabbits anesthetized using a Bain coaxial breathing system with high fresh gas flows.
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Affiliation(s)
- Tanya Duke-Novakovski
- Department of Small Animal Clinical Studies, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Masako Fujiyama
- Department of Small Animal Clinical Studies, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Shannon G Beazley
- Department of Small Animal Clinical Studies, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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18
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The Use of Catheter Mount Will Result in More Reliable Carbon Dioxide Monitoring under Fluid Exposing Conditions. Emerg Med Int 2019; 2019:4120127. [PMID: 31354998 PMCID: PMC6632495 DOI: 10.1155/2019/4120127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/30/2019] [Accepted: 06/12/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Capnometer can be readily malfunctioned by fluid exposure during treatment of critically ill patients. This study aimed to determine whether placing capnometer distant from the endotracheal tube by connecting direct connect catheter mount (DCCM) is effective in yielding reliable end-tidal carbon dioxide (ETCO2) by reducing capnometer malfunctioning caused by water exposure. Methods In 25 healthy adults, a prospective, open label, crossover study was conducted to examine the effect of DCCM in mainstream and microstream capnometers under water exposing conditions. The primary endpoint was the comparison of ETCO2 between proximal DCCM (pDCCM) and distal DCCM (dDCCM). Results For mainstream capnometers, mean ETCO2 was significantly (p < 0.001) higher in dDCCM compared to pDCCM under water exposing conditions (29.5 vs. 19.0 with 5 ml; 33.8 vs. 21.2 with 10 ml; mmHg). Likewise, for microstream capnometers, ETCO2 was greatly higher (p < 0.001) in dDCCM compared to pDCCM (30.5 vs. 13.9 with 5 ml; 29.9 vs.11.4 with 10 mL; mmHg). ETCO2 measured by dDCCM was reliable in microstream settings, whereas it was unreliable in mainstream (correlation coefficient 0.88 vs. 0.27). Conclusions Application of DCCM onto the capnometer setting seems to be effective in reducing capnometer malfunctioning under fluid exposing conditions, which is obvious in microstream capnometer by producing more reliable ETCO2.
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Hochwald O, Borenstein-Levin L, Dinur G, Jubran H, Ben-David S, Kugelman A. Continuous Noninvasive Carbon Dioxide Monitoring in Neonates: From Theory to Standard of Care. Pediatrics 2019; 144:peds.2018-3640. [PMID: 31248940 DOI: 10.1542/peds.2018-3640] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 11/24/2022] Open
Abstract
Ventilatory support may affect the short- and long-term neurologic and respiratory morbidities of preterm infants. Ongoing monitoring of oxygenation and ventilation and control of adequate levels of oxygen, pressures, and volumes can decrease the incidence of such adverse outcomes. Use of pulse oximetry became a standard of care for titrating oxygen delivery, but continuous noninvasive monitoring of carbon dioxide (CO2) is not routinely used in NICUs. Continuous monitoring of CO2 level may be crucial because hypocarbia and hypercarbia in extremely preterm infants are associated with lung and brain morbidities, specifically bronchopulmonary dysplasia, intraventricular hemorrhage, and cystic periventricular leukomalacia. It is shown that continuous monitoring of CO2 levels helps in maintaining stable CO2 values within an accepted target range. Continuous monitoring of CO2 levels can be used in the delivery room, during transport, and in infants receiving invasive or noninvasive respiratory support in the NICU. It is logical to hypothesize that this will result in better outcome for extremely preterm infants. In this article, we review the different noninvasive CO2 monitoring alternatives and devices, their advantages and disadvantages, and the available clinical data supporting or negating their use as a standard of care in NICUs.
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Affiliation(s)
- Ori Hochwald
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and .,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Liron Borenstein-Levin
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil Dinur
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Huda Jubran
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shlomit Ben-David
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amir Kugelman
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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20
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Vesoulis ZA, Liao SM, Mathur AM. Delayed cord clamping is associated with improved dynamic cerebral autoregulation and decreased incidence of intraventricular hemorrhage in preterm infants. J Appl Physiol (1985) 2019; 127:103-110. [PMID: 31046516 DOI: 10.1152/japplphysiol.00049.2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Delayed cord clamping (DCC) improves neurologic outcomes in preterm infants through a reduction in intraventricular hemorrhage (IVH) incidence. The mechanism behind this neuroprotective effect is not known. Infants born <28 wk gestation were recruited for longitudinal monitoring. All infants underwent 72 h of synchronized near-infrared spectroscopy (NIRS) and mean arterial blood pressure (MABP) recording within 24 h of birth. Infants with DCC were compared with control infants with immediate cord clamping (ICC), controlling for severity of illness [clinical risk index for babies (CRIB-II) score], chorioamnionitis, antenatal steroids, sedation, inotropes, and delivery mode. Autoregulatory dampening was calculated as the transfer function gain coefficient between the MABP and NIRS signals. Forty-five infants were included (DCC; n = 15, paired 2:1 with ICC controls n = 30). ICC and DCC groups were similar including gestational age (25.5 vs. 25.2 wk, P = 0.48), birth weight (852.3 vs. 816.6 g, P = 0.73), percent female (40 vs. 40%, P = 0.75), and dopamine usage (27 vs. 23%, P = 1.00). There was a significant difference in IVH incidence between the DCC and ICC groups (20 vs. 50%, P = 0.04). Mean MABP was not different (35.9 vs. 35.1 mmHg, P = 0.44). Compared with the DCC group, the ICC group had diminished autoregulatory dampening capacity (-12.96 vs. -15.06 dB, P = 0.01), which remained significant when controlling for confounders. Dampening capacity was, in turn, strongly associated with decreased risk of IVH (odds ratio = 0.14, P < 0.01). The results of this pilot study demonstrate that DCC is associated with improved dynamic cerebral autoregulatory function and may be the mechanism behind the decreased incidence of IVH. NEW & NOTEWORTHY The neuroprotective mechanism of delayed cord clamping in premature infants is unclear. Delayed cord clamping was associated with improved cerebral autoregulatory function and a marked decrease in intraventricular hemorrhage (IVH). Improved dynamic cerebral autoregulation may decrease arterial baroreceptor sensitivity, thereby reducing the risk of IVH.
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Affiliation(s)
- Zachary A Vesoulis
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine , St. Louis, Missouri
| | - Steve M Liao
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine , St. Louis, Missouri
| | - Amit M Mathur
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine , St. Louis, Missouri
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21
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Lin HJ, Huang CT, Hsiao HF, Chiang MC, Jeng MJ. End-tidal carbon dioxide measurement in preterm infants with low birth weight. PLoS One 2017; 12:e0186408. [PMID: 29040312 PMCID: PMC5645127 DOI: 10.1371/journal.pone.0186408] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 09/29/2017] [Indexed: 02/06/2023] Open
Abstract
Objective There are conflicting data regarding the use of end-tidal carbon dioxide (PetCO2) measurement in preterm infants. The aim of this study was to evaluate the effects of different dead space to tidal volume ratios (VD/VT) on the correlation between PetCO2 and arterial carbon dioxide pressure (PaCO2) in ventilated preterm infants with respiratory distress syndrome (RDS). Methods We enrolled ventilated preterm infants (with assist control mode or synchronous intermittent mandatory mode) with RDS who were treated with surfactant in this prospective study. Simultaneous PetCO2 and PaCO2 data pairs were obtained from ventilated neonates monitored using mainstream capnography. Data obtained before and after surfactant treatment were also analyzed. Results One-hundred and one PetCO2 and PaCO2 pairs from 34 neonates were analyzed. There was a moderate correlation between PetCO2 and PaCO2 values (r = 0.603, P < 0.01). The correlation was higher in the post-surfactant treatment group (r = 0.786, P < 0.01) than the pre-surfactant treatment group (r = 0.235). The values of PaCO2 and PetCO2 obtained based on the treatment stage of surfactant therapy were 42.4 ± 8.6 mmHg and 32.6 ± 7.2 mmHg, respectively, in pre-surfactant treatment group, and 37.8 ± 10.3 mmHg and 33.7 ± 9.3 mmHg, respectively, in the post-surfactant treatment group. Furthermore, we found a significant decrease in VD/VT in the post-surfactant treatment group when compared to the pre-surfactant treatment group (P = 0.003). Conclusions VD/VT decreased significantly after surfactant therapy and the correlation between PetCO2 and PaCO2 was higher after surfactant therapy in preterm infants with RDS.
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Affiliation(s)
- Hsin-Ju Lin
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Tzu Huang
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiu-Feng Hsiao
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- * E-mail: (MCC); (MJJ)
| | - Mei-Jy Jeng
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Pediatrics, Children’s Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail: (MCC); (MJJ)
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22
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van der Heijden HHACM, Truin GJ, Verhaeg J, van der Pol P, Lemson J. Validity of sidestream endtidal carbon dioxide measurement in critically ill, mechanically ventilated children. Paediatr Anaesth 2016; 26:294-9. [PMID: 26714621 DOI: 10.1111/pan.12827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Capnography is used to monitor the endtidal carbon dioxide tension (EtCO2) in exhaled gas. Sidestream capnography has great potential to monitor mechanically ventilated pediatric patients, given the continuous sampling from the endotracheal tube into a gas sensor. However, hemodynamic and respiratory impairments may reduce reliability and validity of sidestream capnography to monitor arterial carbon dioxide tension (PaCO2) in critically ill, mechanically ventilated children. METHODS In 47 mechanically ventilated pediatric patients (aged 0-14 years, median age 17.2 months), a total of 341 consecutive measurements of PaCO2, EtCO2, respiratory and hemodynamic parameters were performed, and capnogram shape was determined. Validity was assessed with the Bland-Altman limit of agreement (loa), mixed models were used to adjust for variation between patients, and potential confounders were considered with multivariable analyses. RESULTS EtCO2 (mean 4.50 ± 0.96 kPa) underestimated PaCO2 (mean 5.37 ± 0.87) considerably, resulting in a loa of 0.87 kPa [95% confidence interval (95% CI) -1.03;2.77] and 42.2% percentage error. The association improved significantly b = 0.54 [95 %CI = 0.45;0.64, P < 0.001] when corrected for individual differences. The association between EtCO2 and PaCO2 was not influenced by any of the potential confounders. CONCLUSIONS Sidestream capnography in mechanically ventilated infants and children seems moderately reliable and valid when corrected for individual differences. Therefore, it could only be used with caution for trend estimation in the individual patient.
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Affiliation(s)
| | - Gerben J Truin
- Department of Pediatrics, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Joyce Verhaeg
- Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Peggy van der Pol
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Joris Lemson
- Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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23
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Lemyre B, Sample M, Lacaze-Masmonteil T. Minimizing blood loss and the need for transfusions in very premature infants. Paediatr Child Health 2016; 20:451-62. [PMID: 26744559 DOI: 10.1093/pch/20.8.451] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Reducing blood loss and the need for blood transfusions in extremely preterm infants is part of effective care. Delayed cord clamping is well supported by the evidence and is recommended for infants who do not immediately require resuscitation. Cord milking may be an alternative to delayed cord clamping; however, more research is needed to support its use. In view of concerns regarding the increased risk for cognitive delay, clinicians should avoid using hemoglobin transfusion thresholds lower than those tested in clinical trials. Higher transfusion volumes (15 mL/kg to 20 mL/kg) may decrease exposure to multiple donors. Erythropoietin is not recommended for routine use due to concerns about retinopathy of prematurity. Elemental iron supplementation (2 mg/kg/day to 3 mg/kg/day once full oral feeds are achieved) is recommended to prevent later iron deficiency anemia. Noninvasive monitoring (eg, for carbon dioxide, bilirubin) and point-of-care testing reduce the need for blood sampling. Clinicians should strive to order the minimal amount of blood sampling required for safe patient care, and cluster samplings to avoid unnecessary skin breaks.
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24
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Kugelman A, Golan A, Riskin A, Shoris I, Ronen M, Qumqam N, Bader D, Bromiker R. Impact of Continuous Capnography in Ventilated Neonates: A Randomized, Multicenter Study. J Pediatr 2016; 168:56-61.e2. [PMID: 26490126 DOI: 10.1016/j.jpeds.2015.09.051] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/31/2015] [Accepted: 09/15/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the time spent within a predefined safe range of CO2 (30-60 mmHg) during conventional ventilation between infants who were monitored with distal end-tidal CO2 (dETCO2, or capnography) and those who were not. STUDY DESIGN For this randomized, controlled multicenter study, ventilated infants with a double-lumen endotracheal tube were randomized to 1 of 2 groups: the open (monitored) group, in which data from the capnograph were recorded, displayed to the medical team, and used for patient care, and the masked group, in which data from the capnograph were recorded. However, the measurements were masked and not available for patient care. dETCO2 was compared with PaCO2 measurements recorded for patient care. RESULTS Fifty-five infants (25 open, 30 masked) participated in the study (median gestational age, 28.6 weeks; range, 23.5-39.0 weeks). The 2 groups were comparable. dETCO2 was in good correlation (r = 0.73; P < .001) and adequate agreement (mean ± SD of the difference, 3.0 ± 8.5 mmHg) with PaCO2. Compared with infants in the masked group, those in the monitored group had significantly (P = .03) less time with an unsafe dETCO2 level (high: 3.8% vs 8.8% or low: 3.8% vs 8.9%). The prevalence of intraventricular hemorrhage or periventricular leukomalacia rate was lower in the monitored group (P = .02) and was significantly (P < .05) associated with the independent factors dETCO2 monitoring and gestational age. CONCLUSION Continuous dETCO2 monitoring improved control of CO2 levels within a safe range during conventional ventilation in a neonatal intensive care unit. TRIAL REGISTRATION ClinicalTrials.gov: NCT01572272.
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Affiliation(s)
- Amir Kugelman
- Department of Neonatology, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Pediatric Pulmonary Unit, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Agenta Golan
- Department of Neonatology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Arieh Riskin
- Department of Neonatology, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Irit Shoris
- Department of Neonatology, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michal Ronen
- Department of Research and Development, Covidien Respiratory and Monitoring Solutions, Jerusalem, Israel
| | - Nelly Qumqam
- Department of Neonatology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - David Bader
- Department of Neonatology, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ruben Bromiker
- Department of Neonatology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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25
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Lemyre B, Sample M, Lacaze-Masmonteil T. Limiter les pertes de sang et le recours aux transfusions chez les grands prématurés. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.8.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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26
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Reiterer F, Sivieri E, Abbasi S. Evaluation of bedside pulmonary function in the neonate: From the past to the future. Pediatr Pulmonol 2015; 50:1039-50. [PMID: 26139200 DOI: 10.1002/ppul.23245] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/01/2015] [Accepted: 05/08/2015] [Indexed: 01/10/2023]
Abstract
Pulmonary function testing and monitoring plays an important role in the respiratory management of neonates. A noninvasive and complete bedside evaluation of the respiratory status is especially useful in critically ill neonates to assess disease severity and resolution and the response to pharmacological interventions as well as to guide mechanical respiratory support. Besides traditional tools to assess pulmonary gas exchage such as arterial or transcutaenous blood gas analysis, pulse oximetry, and capnography, additional valuable information about global lung function is provided through measurement of pulmonary mechanics and volumes. This has now been aided by commercially available computerized pulmonary function testing systems, respiratory monitors, and modern ventilators with integrated pulmonary function readouts. In an attempt to apply easy-to-use pulmonary function testing methods which do not interfere with the infant́s airflow, other tools have been developed such as respiratory inductance plethysmography, and more recently, electromagnetic and optoelectronic plethysmography, electrical impedance tomography, and electrical impedance segmentography. These alternative technologies allow not only global, but also regional and dynamic evaluations of lung ventilation. Although these methods have proven their usefulness for research applications, they are not yet broadly used in a routine clinical setting. This review will give a historical and clinical overview of different bedside methods to assess and monitor pulmonary function and evaluate the potential clinical usefulness of such methods with an outlook into future directions in neonatal respiratory diagnostics.
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Affiliation(s)
- F Reiterer
- Division of Neonatology, Department of Pediatrics and Adolescence Medicine, Medical University Graz, Graz, Austria
| | - E Sivieri
- Section on Newborn Pediatrics, Pennsylvania Hospital, Philadelphia, Pennsylvania.,Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - S Abbasi
- Section on Newborn Pediatrics, Pennsylvania Hospital, Philadelphia, Pennsylvania.,Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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27
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Mehta H, Kashyap R, Trivedi S. Correlation of end tidal and arterial carbon dioxide levels in critically Ill neonates and children. Indian J Crit Care Med 2014; 18:348-53. [PMID: 24987232 PMCID: PMC4071677 DOI: 10.4103/0972-5229.133874] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM OF THE STUDY End tidal carbon dioxide (EtCO2) monitoring is considered to reflect real-time estimation of partial pressure of carbon dioxide in arterial blood (PaCO2) noninvasively. However, knowledge about its relationship with PaCO2 in critically ill pediatric and neonatal patients is limited. The primary objective was to evaluate predictive capability of end tidal carbon dioxide monitoring and secondary objective was to determine the influence of severity of lung disease on EtCO2 and PaCO2 relationship. MATERIALS AND METHODS This was a prospective, nonrandomized, consecutive enrollment study carried out in neonatal and pediatric intensive care units of a tertiary care children hospital. It was conducted in 66 neonates and 35 children receiving mechanical ventilation. Severity of lung disease was estimated by ventilation index and PaO2/FiO2 (P/F) ratio. Simultaneous recording of EtCO2 and PaCO2 levels was done and data were analyzed for correlation and agreement. RESULTS In neonates, 150 EtCO2 and PaCO2 pairs were recorded. The mean weight ± SD of patients was 2.1 ± 0.63 kg. PaCO2 had a positive correlation with EtCO2 (r = 0.836, 95% CI = 0.78-0.88). P/F ratio <200 adversely affected relationship. In infants and children, 96 pairs were recorded. Mean age ± SD of patients was 4.20 ± 4.92 years and mean weight ± SD was 13.1 ± 9.49 kg. PaCO2 had an excellent correlation with EtCO2 (r = 0.914, 95% CI = 0.87 and 0.94). P/F ratio <200 adversely affected relationship. CONCLUSION EtCO2 monitoring displayed a good validity to predict PaCO2. Correlation was affected by low P/F ratio (<200); hence, it is recommended that blood gases be measured in these patients until such time that a good relation can be established between end tidal and arterial CO2 values.
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Affiliation(s)
- Hiren Mehta
- Department of Pediatric Intensive Care, Clinical Fellow, PICU, Royal Manchester Children's Hospital, Oxford road, Manchester, UK ; Resident Physician, KGP Children Hospital, Karelibaugh, Vadodara, Gujarat, India
| | - Rahul Kashyap
- Departments of Anesthesia and Critical Care Medicine, Mayo Clinic Children's Center, Rochester, MN, USA
| | - Sangita Trivedi
- Department of Pediatric Critical Care, Mayo Clinic Children's Center, Rochester, MN, USA ; Consultant Pediatrician and Director, PICU, Karelibaugh, Vadodara, Gujarat, India
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28
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McCann ME, Schouten ANJ. Beyond survival; influences of blood pressure, cerebral perfusion and anesthesia on neurodevelopment. Paediatr Anaesth 2014; 24:68-73. [PMID: 24267703 DOI: 10.1111/pan.12310] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 02/04/2023]
Abstract
Neonates have a higher perioperative mortality risk largely due to the degree of prior illness of the infants, the complexity of their surgeries, and infant physiology. It is important to consider contributing anesthetic factors during the perioperative period that may affect cerebral perfusion and neurocognitive outcome, such as alterations in hemodynamics and ventilation. Limitations of blood pressure as a marker for cerebral perfusion are discussed, as well as the effect of hypocapnia on the brain.
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Affiliation(s)
- Mary Ellen McCann
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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29
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Yang J, Wang H, Wang B, Wang L. Accurate and stable continuous monitoring module by mainstream capnography. J Clin Monit Comput 2013; 28:363-9. [PMID: 24311023 DOI: 10.1007/s10877-013-9541-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/30/2013] [Indexed: 10/25/2022]
Abstract
End-tidal partial pressure of [Formula: see text] is an important index in clinical monitoring. Medical mainstream capnography has become widely used, but there are still limitations in accuracy and stability. A type of mainstream capnometer based on the principle of non-dispersive infrared was designed. This capnometer inhibits signal drift by using electric modulation and thus ensures the accuracy of long-term CO2 monitoring. Statistical methods are used to find the best setting for sampling respiratory signals and improving precision. Several digital filtering techniques are used to process various interferences and improve capnogram quality. Clinical tests and targeted experiments show this mainstream capnometer can accurately monitor respiratory CO2 concentrations, especially at the end-tidal peak point. This capnometer also shows high accuracy and stability in long-term continuous monitoring.
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Affiliation(s)
- Jiachen Yang
- School of Electronic Information Engineering, Tianjin University, Tianjin, People's Republic of China
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