Evaluation of a Capno-Flo resuscitator during transport of critically ill children.

Abstract

Critically ill children often require endotracheal intubation prior to transport to a tertiary care center. Correct endotracheal tube (ETT) placement (trachea vs esophagus) and maintenance of ETT position during transport are of utmost importance. We evaluated the use of a Capno-Flo resuscitator (ventilation bag with a pH-sensitive colorimetric strip in the patient connector; Kirk Specialty Systems, Carrollton, TX) during transport of critically ill children. Thirty-nine intubations were evaluated in 38 patients (one patient was intubated twice) aged 1 day to 19 years (median age, 13 mo) and weighing 0.9 to 80 kg (median weight, 11 kg) who were intubated and transported by air ( = 26, 68%) and ground ambulance ( = 12, 32%). ETT position was confirmed by physical examination, pulse oximetry, and in some patients, arterial blood gases and chest roentgenograms. ETT position was also assessed using the Capno-Flo after six breaths after intubation and was read as positive if the color changed from purple to yellow (tracheal tube position) and negative if the strip remained purple (esophageal tube position). The Capno-Flo ambu-bag was used continuously during transport and evaluated by the nurses or respiratory therapists, who also completed a brief questionnaire. Two esophageal and 37 tracheal tube positions were correctly identified by the device. There were no false-positive or false-negative results; the device was 100% sensitive and specific for the initial reading. It sometimes took longer to obtain this initial reading (> six breaths) in three patients. During transport, most personnel (36/38) noted minimal or no color change during inspiration and expiration, and therefore, it was not helpful in the continued verification of ETT position. The Capno-Flo resuscitator is useful in the initial confirmation of ETT position but not for continuous evaluation of ETT position during transport.