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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Milner, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, Marc J.N.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Ogata, Edward / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland

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A role of end-tidal CO2 monitoring for assessment of tracheal intubations in very low birth weight infants during neonatal resuscitation at birth

Shigeharu Hosono
  • 1Department of Pediatrics and Child Health, Division of Neonatology, Nihon University School of Medicine, Tokyo, Japan
/ Ikuhiro Inami
  • 2Department of Pediatrics and Child Health, Division of Neonatology, Nihon University School of Medicine, Tokyo, Japan
/ Hidetoshi Fujita
  • 3Department of Pediatrics and Child Health, Division of Neonatology, Nihon University School of Medicine, Tokyo, Japan
/ Michiyoshi Minato
  • 4Department of Pediatrics and Child Health, Division of Neonatology, Nihon University School of Medicine, Tokyo, Japan
/ Shigeru Takahashi
  • 5Department of Pediatrics and Child Health, Division of Neonatology, Nihon University School of Medicine, Tokyo, Japan
/ Hideo Mugishima
  • 6Department of Pediatrics and Child Health, Division of Neonatology, Nihon University School of Medicine, Tokyo, Japan
Published Online: 2008-10-31 | DOI: https://doi.org/10.1515/JPM.2009.017

Abstract

Aim: To investigate whether end-tidal CO2 monitoring is useful for more rapid recognition of tracheal vs. esophageal intubation as compared to standard clinical evaluation in very low birth weight infants during neonatal resuscitation at birth.

Patients and methods: Forty infants were prospectively identified. Tracheal tube placement was evaluated either using an end-tidal CO2 monitor by an investigator not involved in the resuscitation, or by evaluation of clinical parameters by a resuscitation team unaware of the end-tidal CO2 data. The time taken to detect accurate placement of the tube using capnometory vs. clinical determination of tracheal or esophageal tube placement was compared.

Results: A total of 54 intubations was analyzed from 40 neonates. End-tidal CO2 monitoring correctly identified all 40 tracheal and all 11 esophageal intubations with 100% accuracy. On the other hand, clinical evaluation demonstrated discrepancies in three cases. The mean time in seconds for capnographic determination was significantly faster than clinical determination for both tracheal (7.5±1.3 vs. 17.0±3.4, P<0.01) and esophageal intubation (6.5±0.7 vs. 19.9±1.8, P<0.01).

Conclusion: Exhaled CO2 detection is a sensitive and accurate technique to confirm tracheal tube placement in very low birth weight infants during neonatal resuscitation.

Keywords: Capnography; delivery room; end-tidal carbon dioxide; esophageal intubation; extremely low birth weight infant; resuscitation; tracheal intubation

Corresponding author: Shigeharu Hosono, MD, PhD Department of Pediatrics and Child Health Division of Neonatology Nihon University School of Medicine 30-1 Oyaguchi Itabashi Tokyo 173-8610 Japan Tel.: +81 3 3972 8111 Fax: +81 3 3957 6186


Received: 2008-02-05

Revised: 2008-07-28

Accepted: 2008-08-28

Published Online: 2008-10-31

Published Online: 2008-10-31

Published in Print: 2009-01-01


Citation Information: Journal of Perinatal Medicine. Volume 37, Issue 1, Pages 79–84, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/JPM.2009.017, October 2008

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