End-tidal CO2 Detector Research Articles

Neonatal Resuscitation Practices in Portuguese Delivery Rooms: A Cross-Sectional Study.

Data from previous studies have demonstrated inconsistency between current evidence and delivery room resuscitation practices in developed countries. The primary aim of this study was to assess the quality of newborn healthcare and resuscitation practices in Portuguese delivery rooms, comparing current practices with the 2021 European Resuscitation Council guidelines. The secondary aim was to compare the consistency of practices between tertiary and non-tertiary centers across Portugal. An 87-question survey concerning neonatal care was sent to all physicians registered with the Portuguese Neonatal Society via email. In order to compare practices between centers, participants were divided into two groups: Group A (level III and level IIb centers) and Group B (level IIa and I centers). A descriptive analysis of variables was performed in order to compare the two groups. In total, 130 physicians responded to the survey. Group A included 91 (70%) and Group B 39 (30%) respondents. More than 80% of participants reported the presence of a healthcare professional with basic newborn resuscitation training in all deliveries, essential equipment in the delivery room, such as a resuscitator with a light and heat source, a pulse oximeter, and an O2 blender, and performing delayed cord clamping for all neonates born without complications. Less than 60% reported performing team briefing before deliveries, the presence of electrocardiogram sensors, end-tidal CO2 detector, and continuous positive airway pressure in the delivery room, and monitoring the neonate's temperature. Major differences between groups were found regarding staff attending deliveries, education, equipment, thermal control, umbilical cord management, vital signs monitoring, prophylactic surfactant administration, and the neonate's transportation out of the delivery room. Overall, adherence to neonatal resuscitation international guidelines was high among Portuguese physicians. However, differences between guidelines and current practices, as well as between centers with different levels of care, were identified. Areas for improvement include team briefing, ethics, education, available equipment in delivery rooms, temperature control, and airway management. The authors emphasize the importance of continuous education to ensure compliance with the most recent guidelines and ultimately improve neonatal health outcomes.

Neonatal resuscitation practices in Italy: a survey of the Italian Society of Neonatology (SIN) and the Union of European Neonatal and Perinatal Societies (UENPS)

BackgroundProviding appropriate care at birth remains a crucial strategy for reducing neonatal mortality and morbidity. We aimed to evaluate the consistency of practice and the adherence to the international guidelines on neonatal resuscitation in level-I and level-II Italian birth hospitals.MethodsThis was a cross-sectional electronic survey. A 91-item questionnaire focusing on current delivery room practices in neonatal resuscitation was sent to the directors of 418 Italian neonatal facilities.ResultsThe response rate was 61.7% (258/418), comprising 95.6% (110/115) from level-II and 49.0% (148/303) from level-I centres. In 2018, approximately 300,000 births occurred at the participating hospitals, with a median of 1664 births/centre in level-II and 737 births/centre in level-I hospitals. Participating level-II hospitals provided nasal-CPAP and/or high-flow nasal cannulae (100%), mechanical ventilation (99.1%), HFOV (71.0%), inhaled nitric oxide (80.0%), therapeutic hypothermia (76.4%), and extracorporeal membrane oxygenation ECMO (8.2%). Nasal-CPAP and/or high-flow nasal cannulae and mechanical ventilation were available in 77.7 and 21.6% of the level-I centres, respectively. Multidisciplinary antenatal counselling was routinely offered to parents at 90.0% (90) of level-II hospitals, and 57.4% (85) of level-I hospitals (p < 0.001). Laryngeal masks were available in more than 90% of participating hospitals while an end-tidal CO2 detector was available in only 20%. Significant differences between level-II and level-I centres were found in the composition of resuscitation teams for high-risk deliveries, team briefings before resuscitation, providers qualified with full resuscitation skills, self-confidence, and use of sodium bicarbonate.ConclusionsThis survey provides insight into neonatal resuscitation practices in a large sample of Italian hospitals. Overall, adherence to international guidelines on neonatal resuscitation was high, but differences in practice between the participating centres and the guidelines exist. Clinicians and stakeholders should consider this information when allocating resources and planning perinatal programs in Italy.

Non-invasive carbon dioxide monitoring in neonates: methods, benefits, and pitfalls.

Wide fluctuations in partial pressure of carbon dioxide (PaCO2) can potentially be associated with neurological and lung injury in neonates. Blood gas measurement is the gold standard for assessing gas exchange but is intermittent, invasive, and contributes to iatrogenic blood loss. Non-invasive carbon dioxide (CO2) monitoring has become ubiquitous in anesthesia and critical care and is being increasingly used in neonates. Two common methods of non-invasive CO2 monitoring are end-tidal and transcutaneous. A colorimetric CO2 detector (a modified end-tidal CO2 detector) is recommended by the International Liaison Committee on Resuscitation (ILCOR) and the American Academy of Pediatrics to confirm endotracheal tube placement. Continuous CO2 monitoring is helpful in trending PaCO2 in critically ill neonates on respiratory support and can potentially lead to early detection and minimization of fluctuations in PaCO2. This review includes a description of the various types of CO2 monitoring and their applications, benefits, and limitations in neonates.

Assessment of endotracheal tube placement in newborn infants: a randomized controlled trial.

International resuscitation guidelines recommend clinical assessment and exhaled CO2 to confirm tube placement immediately after intubation. However, exhaled CO2 devices can display false negative results. In comparison, any respiratory function monitor can be used to measure and display gas flow in and out of an endotracheal tube. However, neither method has been examined in detail. We hypothesized that a flow sensor would improve the assessment of tracheal vs esophageal tube placement in neonates with a higher success rate and a shorter time to tube placement confirmation when compared with the use of a quantitative end-tidal CO2 (ETCO2) detector. Between December 2013 and September 2014, preterm and term infants requiring endotracheal intubation were eligible for inclusion and randomly allocated to either ETCO2 ('ETCO2 group') or flow sensor ('flow sensor group'). All infants were analyzed according to their group at randomization (that is, analysis was by intention-to-treat). During the study period, a total of 110 infants (n=55 for each group) were randomized. Successful endotracheal tube placements were correctly identified in 100% of cases by the flow sensor compared with 72% of cases with the ETCO2 detector within 10 inflations (P<0.05). The median (interquartile range) number of inflations needed to identify successful tube placement was significantly lower in the flow sensor group with 2 (1 to 3) inflations vs 8 (6 to 10) inflations with the ETCO2 detector (P<0.001). A flow sensor would improve the assessment of successful endotracheal tube placement with a higher success rate and a shorter time compared with an ETCO2 detector.

Bringing back the old: time to reevaluate the high-frequency ventilation strategy

To examine the role of frequency in high-frequency ventilation (HFV) on carbon-dioxide (CO2) elimination and lung injury, independent of its effect on tidal volume. An anatomically representative lung model was attached to a mechanical ventilator capable of providing HFV with a constant volume. CO2 was infused directly into the lung, and a commercially available end-tidal CO2 detector was used to determine CO2 elimination. CO2 elimination and amplitude of pressure transmissions were evaluated using frequencies ranging from 5 to 15 Hz. The pressure-volume index (PVI) was described as the product of the volume and pressures delivered to the lung, a surrogate for lung injury. The use of increasing frequencies directly correlated with improved CO2 clearance when keeping the tidal volume fixed, expressed as percent CO2 remaining in the lung at 25 s (66.5 (±1.1)%, 50.5 (±0.1)% and 37.8 (±0.3)% at 5, 10 and 15 Hz, respectively, P<0.05). With a fixed tidal volume, there was a decrease in pressure amplitudes transmitted to the lung with a decline in the PVI (53.9 (±2.7) mmHg ml(-1), 41.1 (±0.9) mmHg ml(-1) and 23.4 (±3.6) mmHg ml(-1), at 5, 10 and 15 Hz, respectively, P<0.05). Frequency has a direct relationship with CO2 elimination when tidal volume is fixed. Using low delivered tidal volumes and high frequencies may allow for improved ventilation efficacy, while minimizing lung injury.

Assessment of flow waves and colorimetric CO2 detector for endotracheal tube placement during neonatal resuscitation

AimClinical assessment and end-tidal CO2 (ETCO2) detectors are routinely used to verify endotracheal tube (ETT) placement. However, ETCO2 detectors may mislead clinicians by failing to identify correct placement under a variety of conditions. A flow sensor measures gas flow in and out of an ETT. We reviewed video recordings of neonatal resuscitations to compare a colorimetric CO2 detector (Pedi-Cap®) with flow sensor recordings for assessing ETT placement. MethodsWe reviewed recordings of infants <32 weeks gestation born between February 2007 and January 2010. Airway pressures and gas flow were recorded with a respiratory function monitor. Video recording were used (i) to identify infants who were intubated in the delivery room and (ii) to observe colour change of the ETCO2 detector. Flow sensor recordings were used to confirm whether the tube was in the trachea or not. ResultsOf the 210 infants recorded, 44 infants were intubated in the delivery room. Data from 77 intubation attempts were analysed. In 35 intubations of 20 infants both a PediCap® and flow sensor were available for analysis. In 21 (60%) intubations, both methods correctly identified successful ETT placement and in 3 (9%) both indicated the ETT was not in the trachea. In the remaining 11 (31%) intubations the PediCap® failed to change colour despite the flow wave indicating correct ETT placement. ConclusionColorimetric CO2 detectors may mislead clinicians intubating very preterm infants in the delivery room. They may fail to change colour in spite of correct tube placement in up to one third of the cases.

The Measure of Treatment Agreement Between Portable and Laboratory Blood Gas Measurements in Guiding Protocol-Driven Ventilator Management

Portable blood gas analyzer and monitor devices are increasingly being used to direct ventilator therapy. The purpose of this study was to evaluate the "measure of treatment agreement" between portable and laboratory blood gas measurements used in guiding protocol-driven ventilator management. Using National Institutes of Health Acute Respiratory Distress Syndrome network ventilator management guidelines to manage patient care, measurements taken from the Nonin 8500 M pulse oximeter (SpO2), the Novametrix-610 end-tidal CO2 (ETCO2) detector, and the i-STAT 1 (SaO2, PO2, pH, PCO2) were compared with the recommended treatment from paired laboratory ABL-725 (SaCO2, PO2, pH, PCO2) measurements. Four hundred forty-six intubated adult intensive care unit patients were studied prospectively. Except for the ETCO2 (R2 = 0.460), correlation coefficients between portable and laboratory measurements were high (R2 > or = 0.755). Testing for equivalence, the Nonin-SpO2, iSTAT-PO2, iSTAT-pH, and iSTAT-PCO2 were deemed "equivalent" surrogates to paired ABL measurements. Testing for the limits of agreement found only the iSTAT-PCO2 to be an acceptable surrogate measurement. The measure of treatment agreement between the portable and paired laboratory blood gas measurements were Nonin-SpO2 (68%), iSTAT-SaO2 (73%), iSTAT-PO2 (97%), iSTAT-pH (88%), iSTAT-PCO2 (95%), and Novametrix-ETCO2 (60%). Only the iSTAT-PO2 and the iSTAT-PCO2 achieved the > or =95% treatment agreement threshold to be considered as acceptable surrogates to laboratory measurements. : The iSTAT-PO2 and -PCO2 were portable device measurements acceptable as surrogates to standard clinical laboratory blood gas measurements in guiding protocol-directed ventilator management. The "measure of treatment agreement," based on standardized decisions and measurement thresholds of a protocol, provides a simple method for assessing clinical validity of surrogate measurements.

Blunt multi-system trauma

Dr. Nathan Mick: Today’s case is that of a 46-year-old man who was struck by a car traveling at approximately 35 mph. According to witnesses, the patient was facing the car when he was hit and thrown 20 feet. When first responders arrived, the patient was found to have a Glascow Coma Scale (GSC) score of 6 and obvious bilateral lower extremity deformities. Pre-hospital personnel at the scene called for helicopter evacuation to a trauma center. The helicopter transport team found the patient supine on a long board with his cervical spine immobilized. The GCS was 6 with sonorous respirations. Vitals signs were as follows: heart rate (HR) 120 beats per minute, systolic blood pressure (BP) 120 mm Hg, and respiratory rate (RR) 10 breaths per minute. Two large bore antecubital intravenous (i.v.) lines were placed. He was pre-oxygenated and then intubated using rapid sequence induction with etomidate 20 mg i.v. and succinylcholine 100 mg i.v. Endotracheal tube placement was confirmed with a colorimetric end-tidal CO2 detector; the patient received midazolam 2 mg i.v. and vecuronium 8 mg i.v. En route to the hospital, the patient received 2000 cc of crystalloid i.v. and was noted to be persistently tachycardic. Dr. Eric Nadel: Are there any questions regarding the pre-hospital course? Dr. Barbara Masser: Why did the on-scene personnel elect to call the helicopter rather than transport the patient via ground ambulance? Dr. Stephen Thomas: Due to the extent of the patient’s injuries and the fact that rush hour traffic would delay transport to the nearest level I trauma center, I think that their choice was a prudent one. The question of when and how to best utilize aeromedical transport vehicles in the urban trauma setting has been long debated. It is generally accepted that the combination of timedistance factors and injury severity reliably predicts who might benefit from air transport to a Level I trauma center (1). Dr. Nathan Mick: The patient arrived in the Emergency Department (ED) at 1900 hours, approximately 45 minutes after being struck. The primary survey revealed that he was sedated, chemically paralyzed, and orally intubated; endotracheal tube placement was confirmed by auscultation of bilateral breath sounds and capnography. Femoral and carotid pulses were 2 and equal. The vital signs were BP 80/56 mm Hg, HR 115 beats/minute, mechanically ventilated RR 12 breaths/minute, oxygen saturation 100%. Secondary survey revealed a GCS of 3. There was a 2-cm laceration over the right eye with pupils that were 3 mm, symmetric and non-reactive. There was soft tissue swelling over the left parietal scalp without palpable deformity. The neck was immobilized; the trachea was midline. Examination of the chest revealed bilateral breath sounds with no crepitance or flail segments. The abdomen was non-distended without palpable masses.

Evaluation of an ambu-bag valve with a self-contained, colorimetric end-tidal CO2 system in the detection of airway mishaps: an animal trial.

Capno-Flo (Kirk Specialty Systems, Carrouton, TX) is a portable pulmonary resuscitator (self inflating ambu-bag--valve system) with a self-contained, colorimetric end-tidal CO2 detector that has the ability to provide continuous CO2 monitoring for up to 2 hours. The purpose of this study is to determine the accuracy and time interval for the Capno-Flo monitor to detect acute airway obstructions and hypopharyngeal extubations in an intubated animal model. Five anesthetized, non-paralyzed, mechanically ventilated Yorkshire minipigs. Complete and partial airway obstruction was simulated with complete and partial cross-clamping of the endotracheal (ET) tube. Placement of the ET tube into the hypopharynx was performed to simulate accidental extubation. In addition to the Capno-Flo colorimetric indicator, both sidestream (SS) and mainstream (MS) capnography were used to monitor end-tidal CO2 and comparison. The time intervals for the capnograph wave to flatten and for the monitor to display "zero" were recorded after each airway alteration. Each experiment was carried out for 180 seconds, and a total of 25 trials was performed. Complete obstruction produced a color change in the Capno-Flo monitor in 9+/-2 seconds and flattening of the SS and MS waveform in 8+/-2 seconds and 6+/-2 seconds, respectively. The SS and MS monitors displayed zero in 49+/-7 seconds and 19+/-1 seconds, respectively. Partial obstruction did not produce color change, a flattening of the wave, or a monitor display of zero. Hypopharyngeal extubation produced a color change in 10+/-2 seconds, flattening of the SS and MS waveform in 7+/-2 seconds and 7+/-1 seconds, respectively. The SS and MS monitors displayed "zero" in 76+/-16 seconds and 18+/-3 seconds, respectively. The Capno-Flo identified all complete airway obstructions and hypopharyngeal extubations rapidly. The CF monitor performed comparable to the SS and MS capnographs. Neither the Capno-Flo, nor the sidestream, nor the mainstream capnographs detected partial airway obstruction. The clinical application of this portable inexpensive capnometer in the continuous monitoring of the intubated patient, especially the transport patient, should be investigated further.

The Role of the Pediatric Disposable End-Tidal CO2 Detector in Endotracheal Intubation in Newborns. 1605

45 newborns (450-4620 gms) who needed endotracheal intubation were included in a prospective study to test the role of a disposable pediatric entotracheal CO2 detector (Pedi-Cap) in verifying endotracheal tube position. Of the 45 babies 24 (53.3%) were intubated in the delivery room and 21 (46.7%) in the NICU. The Pedi-Cap color indicator correlated with the clinical evaluation and X-ray finding of proper intubation in 30 out of 33 patients (sensitivity 91%, specificity 100%, positive predictive value 100%, and negative predictive value 80%). There were three false negative results in patients with severe cardiorespiratory depression. The Pedi-Cap color indicator correlated with the clinical evaluation for the Et-tube being in the esophagus in 12 out of 12 patients (sensitivity, specificity, positive predictive value and negative predictive value were all 100%). The time required to determine the tube position by clinical evaluation was 0-90 seconds (Mean 39.7 sec. SD±15.3). The time required with the disposable Et-CO2 detector was 4-12 seconds (Mean=8.1 sec. SD±2.9). (p<0.001). The use of disposable pediatric entotracheal CO2 detector significantly reduces the time spent in verifying the endotracheal tube position (trachea vs. esophagus) in newborns including premature babies with body weight <1000 grams. This is of particular benefit to the babies who are erroneously intubated in the esophagus because using the device allows much faster detection of this problem and much earlier reintubation.

Colorimetric end-tidal CO2 detector for verification of endotracheal tube placement in out-of-hospital cardiac arrest.

To evaluate the ability of a disposable, colorimetric end-tidal CO2 detector to verify proper endotracheal (ET) tube placement in out-of-hospital cardiac arrest, and to correlate semiquantitative CO2 measurements with the rate of return of spontaneous circulation (ROSC). Prospective, observational study using a convenience sample of intubated out-of-hospital cardiac arrest patients. A disposable, colorimetric end-tidal CO2 detector was attached to the ET tube after intubation. In the absence of a colorimetric change, the paramedics reassessed the tube placement and could reintubate the patient. Tube placement was verified at the hospital. Paramedics were instructed to contact the base station and report the colorimetric change upon hospital arrival. ROSC was defined as restoration of a self-sustaining pulse until hospital arrival. Between December 1990 and May 1993, ET tubes were placed in 566 victims of out-of-hospital cardiac arrest. 541 of the 566 intubations (95.6%) were associated with a color change. In one case with a color change and out-of-hospital clinical evidence of proper tube placement, the tube was determined to be in the esophagus at the hospital. Correct placement of the remaining 565 of 566 (99.8%) tubes was verified. Of the 566 patients who had a colorimetric change, 91 (16%) had ROSC vs one of 25 (4%) patients who did not have a color change. In one subgroup (n = 179), the degree of color change was highly associated with ROSC (p = 0.004). A disposable, colorimetric end-tidal CO2 detector appears reliable in verifying proper ET tube placement in victims of out-of-hospital cardiac arrest. The degree of color change correlates with the probability of ROSC.

A Note of Caution About the Continuous Use of Colorimetric End-Tidal CO2 Detectors in Children

Colorimetric end-tidal CO2 (ETCO2) detectors (Easy Cap, Nellcor Inc, Hayward, CA) are extremely useful in determining the position of the endotracheal tube (ETT) in the airway and have been validated in animals, children, and adults.1-6 They have not been labelled for use in children weighing 15 kg because of their large dead space of 38 mL.1-3 We have demonstrated in numerous studies that the ETCO2 detector accurately verifies the ETT position in infants weighing &amp;gt;2 kg with spontaneous circulation.1-3

Evaluation of An End-Tidal CO2 Detector During Pediatric Cardiopulmonary Resuscitation

To determine the utility of a disposable colorimetric end-tidal CO2 detector during pediatric cardiopulmonary resuscitation (CPR) for (1) confirming endotracheal tube (ETT) position, and (2) assessing the relationship between end-tidal CO2 recorded by this method and outcome of pediatric CPR. Prospective observations during CPR in a university children's hospital. Forty children (28 male, 12 female) aged 1 week to 10 years (25 children aged < or = 1 year, mean age 27.2 months, median 7 months), weighing 2.5 to 40 kg (31 children weighing < or = 15 kg, mean 10.94 kg, median 7 kg) who underwent a total of 48 endotracheal intubations during CPR. After intubation, ETT position was verified by usual clinical methods including direct visualization. The device was attached between the ETT and ventilation bag, the patient was manually ventilated, and a first reading was obtained. Any color change from purple (Area A, end-tidal CO2 < 0.5%) to tan or yellow (Area B or C, end-tidal CO2 > or = 0.5%) was considered to be positive for airway intubation. CPR was conducted as per Pediatric Advanced Life Support guidelines. A second reading was obtained when the decision to discontinue CPR was made. All nine esophageal tube positions were correctly identified by the detector. Thirty-three of 39 tracheal tube positions were correctly identified (P < .001). For verifying ETT position, the device had a sensitivity of 84.6%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 60%. Readings were obtained at the end of CPR in 25 patients. All 13 patients who regained spontaneous circulation and survived to ICU admission had a second reading in the C range, while none of the 12 patients with a second reading in the A or B range survived. Both the first and second end-tidal CO2 readings in the C range correlated significantly with short-term survival (P = .01 and P < .001, respectively). Two patients were eventually discharged from the hospital. During CPR a positive test confirms placement of the ETT within the airway, whereas a negative test indicates either esophageal intubation or airway intubation with poor or absent pulmonary blood flow and requires an alternate means of confirmation of tube position. The detector may be of prognostic value for return of spontaneous circulation and short-term survival.

Gastric Juice, Drugs, and End-Tidal Carbon Dioxide Detectors

To the Editor.— Since publishing our article "Utility of an End-Tidal Carbon Dioxide Detector During Stabilization and Transport of Critically Ill Children (Pediatrics. 1992;89:1042-1044), it has been brought to our attention,1 and we also have observed that contamination of the end-tidal CO2 detector with gastric acid causes permanent yellow discoloration of the detector. The same is true of direct contact of the detector with resuscitation drugs (epinephrine, atropine, lidocaine).1 Such discoloration has not been observed with deep intratracheal drug administration.2,3

Utility of an End-Tidal Carbon Dioxide Detector During Stabilization and Transport of Critically III Children

Critically ill children often require endotracheal intubation prior to transport to a medical center. Correct endotracheal tube placement and maintenance during transport are essential. The utility of a portable colorimetric end-tidal CO2 detector during transport of critically ill children was evaluated. Fifty-eight children with spontaneous circulation (aged 1 day to 12 years, weight 0.9 to 26 kg) who underwent 59 intubations during transport by ground (n = 31) or air (n = 27) were studied. Tube position was confirmed by physical examination, arterial blood gas values, or arterial oxygen saturation, and sometimes by chest radiograph. The detector was attached and readings were obtained after intubation; readings were repeated if endotracheal tube position was rechecked during transport. Fifty-seven of 58 tracheal positions and the 1 esophageal tube position were correctly identified. One false-negative result occurred in a severely hypocarbic 900-g premature newborn. On each occasion that the detector was used en route, the endotracheal tube position was correctly identified. It is concluded that the end-tidal CO2 detector is a useful tool for confirming endotracheal tube position during transport of critically ill children weighing more than 2 kg who are not in cardiopulmonary arrest.

Accuracy of the FEF CO2 Detector in the Assessment of Endotracheal Tube Placement

The sensitivity and reliability of the FEF end-tidal CO2 detector were investigated for its suitability in the assessment of correct placement of an endotracheal tube. Sensitivity was determined by having eight blinded volunteers observe the color change in the FEF detector with the administration of different volumes and varying CO2 concentrations of gas mixture. The color change in the FEF detector was also assessed during esophageal ventilations before and after administration of carbonated beverage into the stomach of swine and during cardiopulmonary resuscitation in swine. An interpersonal variation was present among the blinded observers during the color-matching process. Different colors were observed with the same volume and CO2 concentration of gas mixture. During esophageal ventilations before or after the administration of carbonated beverage, the FEF detector was neither accurate nor rapid in identifying esophageal placement of the endotracheal tube. The "C" color was displayed during the initial six ventilations in one swine, and esophageal intubation would have been missed. The FEF detector could (by displaying a "C" color) identify one of six correctly intubated swine during cardiopulmonary resuscitation. In conclusion, the FEF CO2 detector does not have the characteristics to reliably assess the correct placement of an endotracheal tube.

Validity of a disposable end-tidal CO2 detector in verifying endotracheal tube placement in infants and children

To examine the validity of a disposable, colorimetric end-tidal CO2 detector in verifying endotracheal tube (ETT) placement in infants and children. The detector was studied prospectively in 151 intubations. Operating room, ICU, and emergency department of a children's hospital. One hundred thirty-seven children undergoing endotracheal intubation for anesthesia (52), respiratory support (76), or CPR (23). After endotracheal intubation, tube position was verified, the detector was attached, and readings were obtained. The detector correctly identified tube position (trachea, 124; esophagus, four) in all 120 patients who were not in cardiac arrest (P less than .01). In the cardiac arrest setting, all six esophageal intubations were correctly identified, but two of the 17 tracheal intubations were incorrectly interpreted as esophageal intubations (P less than .01). The detector accurately identifies ETT position in children with spontaneous circulation who weigh more than 2 kg. During CPR, a positive test correctly indicates that the ETT is in the airway, but a negative result (suggesting esophageal placement) requires an alternate means of confirming ETT position.

Clinical utility of a colorimetric end-tidal CO2 detector in cardiopulmonary resuscitation and emergency intubation

The purposes of this study were to evaluate the clinical utility of a colorimetric end-tidal CO2 (ETCO2) detector in confirming proper endotracheal intubation in patients requiring emergency intubation, to determine if this new device can be used as an adjunct to judge the effectiveness of cardiopulmonary resuscitation (CPR), and to determine whether the device can predict successful resuscitation from cardiopulmonary arrest. We studied prospectively 110 patients requiring emergency intubation for either respiratory distress (53 patients) or cardiopulmonary arrest (57 patients) by recording the color range of the indicator after the initial intubation. In patients who suffered a cardiopulmonary arrest, the color range was also recorded during CPR after the endotracheal tube was confirmed to be in the tracheal position and perfusion optimized, and at the moment CPR was stopped. The ETCO2 detector was 100% specific for correct endotracheal intubation in all patients. It was also highly sensitive (0.98) for correct endotracheal intubation in patients with respiratory distress. However, it was not sensitive (0.62) in patients with cardiopulmonary arrest and low perfusion. The sensitivity improved (0.88) when we used the ETCO2 range obtained after attempts to increase perfusion. A low ETCO2 color range in 19 patients undergoing CPR was interpreted as low cardiac output and prompted the physicians to attempt to increase perfusion. Of the patients who underwent CPR, no patient whose ETCO2 level remained less than 2% was successfully resuscitated. Those patients who had an ETCO2 level greater than or equal to 2% had a significantly higher incidence of successful resuscitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Confirmation of endotracheal tube placement: A miniaturized infrared qualitative Co 2 detector

A miniaturized, infrared, solid-state, end-tidal CO2 detector was used to confirm emergency endotracheal tube (ETT) placement. This prospective, clinical study used a miniature, infrared, solid-state end-tidal CO2 detector to confirm ETT placement in an acute setting. The ICU, emergency department, and hospital floor. There were 88 consecutive adult patients requiring 100 emergency intubations. The indication for airway intervention was considered urgent in 79% and under arrest conditions in 21%. The mean number of intubation attempts was 1.83 (range, one to five) with difficulty of intubation of 6.48 and confirmation of 7.75, on a linear scale from 0 (lowest) to 10 (highest). Determination of ETT position revealed intratracheal intubation in 96% and esophageal intubation in 4%. Placement was confirmed by direct visualization or radiography in all cases. Sensitivity and specificity for ETT localization was 100% (P less than .0001). This hand-held infrared capnometer reliably confirms ETT placement under emergency conditions.

Validity of a disposable end-tidal carbon dioxide detector in verifying endotracheal tube position in piglets

the most reliable methods for confirming endotracheal tube placement are direct visualization of passage through the vocal cords and documentation of CO2 in the expired gas. We evaluated the use of a disposable colorimetric CO2 detector for verifying endotracheal tube position in small animals. The end-tidal CO2 (Petco2) detector was tested in 11 piglets with the endotracheal tube sequentially in the trachea, the esophagus, the esophagus with a carbonated beverage in the stomach, the esophagus after bag-mask ventilation. Endotracheal tube position was confirmed in all cases by direct visualization and capnometry. The Petco2 detector identified the tube placement accurately in all 54 (21 tracheal, 33 esophageal) intubations (p less than .001). This disposable Petco2 detector is highly sensitive and specific for verifying endotracheal tube placement in this nonarrest piglet model.