1996 OPEN FORUM Abstracts
COMPARISON OF A 3CC DEADSPACE COLORIMETRIC C02 DETECTOR WITH CAPNOGRAPHY DURING INTUBATION OF INFANTS LESS THAN 2000 GRAMS.
Susan L. Buck, RRT. Debra R. Jones, RRT. David E. Woodrum, MD. University of Washington Medical Center, Seattle, WA.
BACKGROUND: Premature neonates frequently require endotracheal intubation. Misplacement of the endotracheal tube in the esophagus can result in delay in the initiation of ventilatory support critical for establishing effective ventilation. Capnometry or colorimetry are standards for confirming intubation in populations weighing >2000 grams. Capnography has been used in infants < 2000 grams but the previously developed colorimetric devices have had too much dead space for this population. The utility and accuracy of a disposable, colorimetric ETCO2 detector with only 3 cc dead space, made by Nellcor and called a Pedi-CAP(r), was evaluated and compared to a mainstream capnometer, the Novametrix 1265, during 31 intubation attempts. The study population consisted of 24 infants weighing less than 2000 grams. Less than 1000 grams (n=6), 1000-1200 grams (n=9), 1200-1500 grams (n=7), 1500-2000 (n=2). METHOD: Data was collected on each infant consisting of weight, number of breaths given for exhaled CO2 to be detected, if any, length of time infant was mask-bag ventilated, if any, administration of CPR, if applicable, color change, if any, detected with the Pedi-CAP(r). Immediately after intubation attempts the Novametrix ETCO2 sensor was attached between the ETT and the ventilation bag and digital readings and waveforms observed for at least 6 positive pressure ventilations (PPVs) and data noted. The Pedi-CAP(r) was then attached and at least 6 PPVs given and color changes noted. HR, RR, oximetry, and breath sounds were also monitored during and after intubation attempts. A positive identification of tracheal intubation by the capnometer was a digital number readout with the typical phasic waveforms of respirations within 6 PPVs. A positive identification of esophageal intubation was a zero reading or a digital readout < 10 quickly decreasing to zero within 6 PPVs. A positive identification of tracheal intubation with the Pedi-CAP(r) was a color change from purple to yellow and back again to purple in sync with inspiration and expiration within 6 PPVs. A positive identification of esophageal intubation was no color change, or a very weak color change decreasing to purple within 6 PPVs. Results: 24 tracheal intubations were confirmed with both devices within 6 PPVs. 7 esophageal intubations were confirmed with both devices within 3 PPVs. All infants had spontaneous circulation. 12 of the 24 infants were mask bag ventilated before or between intubation attempts. EXPERIENCE: We found this 3cc ETCO2 sensor to be easy to use and well liked by all the staff in the NICU. It is disposible, portable and simple to use, requiring no maintenance, calibration or cleaning. CONCLUSION: It is concluded that the Pedi-CAP(r) is as reliable as capnography in confirming endotracheal tube placement in infants less than 2000 grams.