End-tidal capnography monitoring in infants ventilated on the neonatal intensive care unit

Emma Williams,Alison Walsh,Anne Greenough,Niamh O’Reilly,Theodore Dassios

doi:10.1038/s41372-021-00978-y

Abstract

ObjectiveTo 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 designA case–control study of a prospective cohort (n = 36) with capnography monitoring and matched historical controls (n = 36).ResultThe 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.ConclusionContinuous 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.

Highlights

Mechanical ventilation can be lifesaving for neonates, but long-term complications are increased in infants who have suffered abnormalities in carbon dioxide (CO2) levels
Disturbances in cerebral blood flow caused by the magnitude of difference in CO2 levels and abnormalities in CO2 levels can lead to intraventricular haemorrhage (IVH) and periventricular leukomalacia (PVL) and subsequent cerebral injury [1, 2]
We have reported that abnormal levels of carbon dioxide, including large magnitude of difference in CO2 levels during resuscitation contribute to IVH development [20]

Summary

Introduction

Mechanical ventilation can be lifesaving for neonates, but long-term complications are increased in infants who have suffered abnormalities in carbon dioxide (CO2) levels. The current gold standard for monitoring CO2 levels in newborn infants is by arterial blood gas analysis [5]. This is the most accurate measurement of CO2 levels, it is not without complications [6]. Follow up of extremely preterm infants exposed to multiple heel prick tests in the neonatal period has shown that this can result in hyperalgesia and increased sensitivity to painful stimuli [9, 10]. The Canadian Paediatric Society, Foetus and Newborn Committee recommend non-invasive CO2 monitoring for ventilated, preterm infants to minimise blood loss and the need for multiple transfusions [14]

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Results

Conclusion