1998 OPEN FORUM Abstracts
CASE STUDY EVALUATING A NEONATAL RESPIRATORY MONITOR: VOLUMETRIC EXHALED CARBON DIOXIDE (VCO2) MONITORING OF A PREMATURE RECEIVING SURFACTANT.
John Emberger BS RRT, Mike Western RRT PPS, Sean Motoyoshi RRT, Dave Lapham BS RRT, Robert Locke DO, Departments of Respiratory Care and Neonatology, Christiana Care Health System, Newark, Delaware.
Background: The Novametrix COSMO Plus Respiratory Monitor (Novametrix Medical Systems, Wallingford CT) previously used in adults, now has neonatal capabilities. The capabilities include: ventilation mechanics, ETCO2, and Volumetric CO2 monitoring (VCO2 - CO2 volume/breath or CO2 production). We want to investigate the correlation of VCO2 to respiratory effort in premature infants. Case Summary: A 29 week gestation premature infant required mechanical ventilation at birth (IMV mode, PIP = 25 cmH2O, PEEP = 5 cmH2O, rate = 30 breaths/minute). The COSMO Plus Monitor was started with mechanical ventilation. Physicians determined that surfactant replacement was required. The graphic shown here represents the trend of the VCO2 and the ETCO2 during the period before and after surfactant was given (Note the arrow where surfactant was given). The ETCO2 was noted to correlate with the ABG (ETCO2 was 1-3 torr below PaCO2) both before and after surfactant was given. The premature infant was noted to have increased respiratory effort (paradoxic breathing pattern with intercostal and subcostal retractions). After the surfactant was given, the retractions subsided and the patient appeared comfortable on the current ventilator settings. Discussion: The premature infant had increased respiratory effort against the low compliance of the lungs. After surfactant was given respiratory effort appeared to dramatically decrease. The COSMO Plus showed a dramatic decrease in VCO2 which we believe correlated to a dramatic reduction in respiratory effort as the surfactant increased lung compliance. Future studies of many prematures may reveal if monitoring VCO2 is of value in trending work of breathing in correlation to weaning prematures from the ventilator.
(See Original for Figure)
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.