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Abstract
Although capnography is a standard tool in mechanically ventilated adult and pediatric patients, it has physiological and technical limitations in neonates. Gas exchange differs between small and adult lungs due to the greater impact of small airways on gas exchange, the higher impact of the apparatus dead space on measurements due to lower tidal volume and the occurrence of air leaks in intubated patients. The high respiratory rate and low tidal volume in newborns, especially those with stiff lungs, require main-stream sensors with fast response times and minimal dead-space or low suction flow when using side-stream measurements. If these technical requirements are not fulfilled, the measured end-tidal CO2 (PetCO2), which should reflect the alveolar CO2 and the calculated airway dead spaces, can be misleading. The aim of this survey is to highlight the current limitations of capnography in very young patients to avoid pitfalls associated with the interpretation of capnographic parameters, and to describe further developments.
Highlights
Acute respiratory disorders in newborns are an important clinical problem, especially in preterm infants [1]
Clinical interest in postnatal lung function measurements at the end of the 19th century resulted in the development of special mechanical spirometers (Fig. 1) to measure tidal volume (VT), respiratory rate (RR) and minute ventilation (V’E) [4, 5]
These mechanical measuring systems, have limitations in newborns, the most important being the high ratio of apparatus dead space (VDapp) to tidal volume (VT), resulting in CO2-rebreathing and a risk of hypercapnia
Summary
Acute respiratory disorders in newborns are an important clinical problem, especially in preterm infants [1]. Gas exchange differs between small and adult lungs due to the greater impact of small airways on gas exchange, the higher impact of the apparatus dead space on measurements due to lower tidal volume and the occurrence of air leaks in intubated patients. The high respiratory rate and low tidal volume in newborns, especially those with stiff lungs, require main-stream sensors with fast response times and minimal dead-space or low suction flow when using side-stream measurements.
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