The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

A BLINDED COMPARISON OF A PEDIATRIC DISPOSABLE END-TIDAL CARBON DIOXIDE DETECTOR VERSUS VITAL SIGNS FOR CONFIRMATION OF ENDOTRACHEAL INTUBATION.

James E. Martin BS. RRT, Hany F. Aziz MD. John J. Moore MD, Departments of Pediatrics and Pulmonary Services, Metro Health Medical Center, Cleveland, OH

Introduction: End-tidal carbon dioxide has been used with great success for confirming endotracheal intubation. A pediatric disposable colorimetric device Pedi-CAP^{TM} (Nellcor) Puritan Bennett, Pleasanton, CA) is now available for detecting the presence of exhaled CO_{2} in infants weighing 1-15 kgs. We sought to determine if the device could enhance confirmation of endotracheal intubation when combined with clinical assessment (CA) and vital signs (VS). Method: Infants requiring intubation for positive pressure ventilation in the Neonatal Intensive Care Unit and Delivery Room were considered candidates for the study. Intubation in the standard fashion was performed by a skilled resuscitation team (SRT) consisting of 3 or more caregivers. Immediately following intubation, the device was placed between the patient's endotracheal tube and the flow-inflated anesthesia bag. A study investigator (SI) who was not part of the resuscitation team blinded the SRT from the results of the exhaled CO_{2} detector. The SI recorded the presence or absence of CO_{2} following 6 manual ventilations by a member of the SRT. The SI continued to monitor and record the time needed by the SRT to confirm intubation. The recording time was stopped when the SRT confirmed intubation by clinical assessment (auscultation of the thorax and epigastrium, symmetrical chest rise, color, activity) and stabilizing or increasing vital signs (HR, SpO_{2}), or if the patient was extubated. The chest x-ray was the definitive confirmation of intubation. Positive and Negative predictive values for the presence of CO_{2} were calculated using CA and VS as the standards. Results: Of 31 patients studied, data from 27 infants was analyzed. 4 patients were excluded, 2 due to SI participation in the resuscitation, and 2 when insufficient time was allowed for VS changes. Patient weight: 470-3100 grams; age at time of intubation: 30 min-2 months; recorded time after CO_{2} detected: 4-10 seconds (mean 5.74); confirmation of intubation by the SRT (clinical assessment + stable or increasing vital signs): 15-55 seconds (mean 28.29). Statistical significance between the confirmation times for the 2 methods was determined using a paired t-test (P < .0001). The device's positive and negative predictive values, specificity, and sensitivity all were 100%.

Intubated(VS) Not Intubated(VS) Total

Intubated (CO_{2}) 20 0 20

Not Intubated (CO_{2}) 0 7 7

Total 20 7 27

Conclusion: The preliminary results suggest that this device is accurate in identifying the presence of CO_{2} and significantly reduces the time spent verifying endotracheal intubation in newborn and infants.

Reference: OF-96-159

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