End-tidal carbon dioxide monitoring in very low birth weight infants: Correlation and agreement with arterial carbon dioxide

Daniele Trevisanuto; Stephanie Giuliotto; Francesco Cavallin; Nicoletta Doglioni; Silvia Toniazzo; Vincenzo Zanardo

doi:10.1002/ppul.21558

End-tidal carbon dioxide monitoring in very low birth weight infants: Correlation and agreement with arterial carbon dioxide

Daniele Trevisanuto, Stephanie Giuliotto, Francesco Cavallin, Nicoletta Doglioni, Silvia Toniazzo, Vincenzo Zanardo

Istituto Oncologico Veneto

Research output: Contribution to journal › Article › peer-review

Abstract

Objective We aimed to determine the correlation and the agreement between end-tidal carbon dioxide (ETCO ₂) and partial pressure of arterial carbon dioxide (PaCO ₂) in very low birth weight infants (VLBWI); furthermore, we assessed factors that could affect the ETCO ₂- PaCO ₂ relationship. Methods Simultaneous end-tidal and arterial CO ₂ pairs were obtained from ventilated VLBWI who were monitored by mainstream capnography and had umbilical arterial catheter. Correlation and agreement between ETCO ₂ and PaCO ₂ were evaluated by using Spearman test and Bland-Altman method, respectively. Results A total of 143 simultaneous ETCO ₂-PaCO ₂ pairs were analyzed from 45 ventilated VLBWI. There was a significant correlation (r = 0.69; P < 0.0001) between ETCO ₂ and PaCO ₂ values. The ETCO ₂ value was lower than the corresponding PaCO ₂ value in 94% pairs, with a mean bias of 13.5 ± 8.4 mmHg (95% agreement levels, -3.0 to 29.9 mmHg). Mean PaCO ₂-ETCO ₂ bias was similar between ELBWI (13.1 ± 7.7 mmHg; 95% agreement levels, -1.9 and 28.2 mmHg) and infants with birth weight 1,001-1,500 g (14.8 ± 9.7 mmHg; 95% agreement levels -4.3 and 33.8 mmHg). The bias between ETCO ₂ and PaCO ₂ was significantly increased with increasing FiO ₂, mean airway pressure and oxygenation index. Within each patient, there was a positive correlation (r = 0.78, P < 0.0001) between the changes in PaCO ₂ and the simultaneous changes in ETCO ₂. Conclusions In ventilated VLBWI, the correlation between mainstream ETCO ₂ and PaCO ₂ is good, but the agreement is poor and negatively influenced by the severity of pulmonary disease. Capnography is feasible in ELBWI. ETCO ₂ should not replace PaCO ₂ measurements in ventilated VLBWI, but may have a role to detect trends of PaCO ₂. Pediatr Pulmonol. 2012; 47:367-372.

Original language	English
Pages (from-to)	367-372
Number of pages	6
Journal	Pediatric Pulmonology
Volume	47
Issue number	4
DOIs	https://doi.org/10.1002/ppul.21558
Publication status	Published - Apr 2012

Keywords

capnography
carbon dioxide monitoring
neonatal intensive care unit
ventilation
very low birth weight infants

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Pulmonary and Respiratory Medicine

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10.1002/ppul.21558

Cite this

@article{e30438fe82c84dc09eaddf6bf7b37b1d,

title = "End-tidal carbon dioxide monitoring in very low birth weight infants: Correlation and agreement with arterial carbon dioxide",

abstract = "Objective We aimed to determine the correlation and the agreement between end-tidal carbon dioxide (ETCO 2) and partial pressure of arterial carbon dioxide (PaCO 2) in very low birth weight infants (VLBWI); furthermore, we assessed factors that could affect the ETCO 2- PaCO 2 relationship. Methods Simultaneous end-tidal and arterial CO 2 pairs were obtained from ventilated VLBWI who were monitored by mainstream capnography and had umbilical arterial catheter. Correlation and agreement between ETCO 2 and PaCO 2 were evaluated by using Spearman test and Bland-Altman method, respectively. Results A total of 143 simultaneous ETCO 2-PaCO 2 pairs were analyzed from 45 ventilated VLBWI. There was a significant correlation (r = 0.69; P < 0.0001) between ETCO 2 and PaCO 2 values. The ETCO 2 value was lower than the corresponding PaCO 2 value in 94% pairs, with a mean bias of 13.5 ± 8.4 mmHg (95% agreement levels, -3.0 to 29.9 mmHg). Mean PaCO 2-ETCO 2 bias was similar between ELBWI (13.1 ± 7.7 mmHg; 95% agreement levels, -1.9 and 28.2 mmHg) and infants with birth weight 1,001-1,500 g (14.8 ± 9.7 mmHg; 95% agreement levels -4.3 and 33.8 mmHg). The bias between ETCO 2 and PaCO 2 was significantly increased with increasing FiO 2, mean airway pressure and oxygenation index. Within each patient, there was a positive correlation (r = 0.78, P < 0.0001) between the changes in PaCO 2 and the simultaneous changes in ETCO 2. Conclusions In ventilated VLBWI, the correlation between mainstream ETCO 2 and PaCO 2 is good, but the agreement is poor and negatively influenced by the severity of pulmonary disease. Capnography is feasible in ELBWI. ETCO 2 should not replace PaCO 2 measurements in ventilated VLBWI, but may have a role to detect trends of PaCO 2. Pediatr Pulmonol. 2012; 47:367-372.",

keywords = "capnography, carbon dioxide monitoring, neonatal intensive care unit, ventilation, very low birth weight infants",

author = "Daniele Trevisanuto and Stephanie Giuliotto and Francesco Cavallin and Nicoletta Doglioni and Silvia Toniazzo and Vincenzo Zanardo",

year = "2012",

month = apr,

doi = "10.1002/ppul.21558",

language = "English",

volume = "47",

pages = "367--372",

journal = "Pediatric Pulmonology",

issn = "8755-6863",

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TY - JOUR

T1 - End-tidal carbon dioxide monitoring in very low birth weight infants

T2 - Correlation and agreement with arterial carbon dioxide

AU - Trevisanuto, Daniele

AU - Giuliotto, Stephanie

AU - Cavallin, Francesco

AU - Doglioni, Nicoletta

AU - Toniazzo, Silvia

AU - Zanardo, Vincenzo

PY - 2012/4

Y1 - 2012/4

N2 - Objective We aimed to determine the correlation and the agreement between end-tidal carbon dioxide (ETCO 2) and partial pressure of arterial carbon dioxide (PaCO 2) in very low birth weight infants (VLBWI); furthermore, we assessed factors that could affect the ETCO 2- PaCO 2 relationship. Methods Simultaneous end-tidal and arterial CO 2 pairs were obtained from ventilated VLBWI who were monitored by mainstream capnography and had umbilical arterial catheter. Correlation and agreement between ETCO 2 and PaCO 2 were evaluated by using Spearman test and Bland-Altman method, respectively. Results A total of 143 simultaneous ETCO 2-PaCO 2 pairs were analyzed from 45 ventilated VLBWI. There was a significant correlation (r = 0.69; P < 0.0001) between ETCO 2 and PaCO 2 values. The ETCO 2 value was lower than the corresponding PaCO 2 value in 94% pairs, with a mean bias of 13.5 ± 8.4 mmHg (95% agreement levels, -3.0 to 29.9 mmHg). Mean PaCO 2-ETCO 2 bias was similar between ELBWI (13.1 ± 7.7 mmHg; 95% agreement levels, -1.9 and 28.2 mmHg) and infants with birth weight 1,001-1,500 g (14.8 ± 9.7 mmHg; 95% agreement levels -4.3 and 33.8 mmHg). The bias between ETCO 2 and PaCO 2 was significantly increased with increasing FiO 2, mean airway pressure and oxygenation index. Within each patient, there was a positive correlation (r = 0.78, P < 0.0001) between the changes in PaCO 2 and the simultaneous changes in ETCO 2. Conclusions In ventilated VLBWI, the correlation between mainstream ETCO 2 and PaCO 2 is good, but the agreement is poor and negatively influenced by the severity of pulmonary disease. Capnography is feasible in ELBWI. ETCO 2 should not replace PaCO 2 measurements in ventilated VLBWI, but may have a role to detect trends of PaCO 2. Pediatr Pulmonol. 2012; 47:367-372.

AB - Objective We aimed to determine the correlation and the agreement between end-tidal carbon dioxide (ETCO 2) and partial pressure of arterial carbon dioxide (PaCO 2) in very low birth weight infants (VLBWI); furthermore, we assessed factors that could affect the ETCO 2- PaCO 2 relationship. Methods Simultaneous end-tidal and arterial CO 2 pairs were obtained from ventilated VLBWI who were monitored by mainstream capnography and had umbilical arterial catheter. Correlation and agreement between ETCO 2 and PaCO 2 were evaluated by using Spearman test and Bland-Altman method, respectively. Results A total of 143 simultaneous ETCO 2-PaCO 2 pairs were analyzed from 45 ventilated VLBWI. There was a significant correlation (r = 0.69; P < 0.0001) between ETCO 2 and PaCO 2 values. The ETCO 2 value was lower than the corresponding PaCO 2 value in 94% pairs, with a mean bias of 13.5 ± 8.4 mmHg (95% agreement levels, -3.0 to 29.9 mmHg). Mean PaCO 2-ETCO 2 bias was similar between ELBWI (13.1 ± 7.7 mmHg; 95% agreement levels, -1.9 and 28.2 mmHg) and infants with birth weight 1,001-1,500 g (14.8 ± 9.7 mmHg; 95% agreement levels -4.3 and 33.8 mmHg). The bias between ETCO 2 and PaCO 2 was significantly increased with increasing FiO 2, mean airway pressure and oxygenation index. Within each patient, there was a positive correlation (r = 0.78, P < 0.0001) between the changes in PaCO 2 and the simultaneous changes in ETCO 2. Conclusions In ventilated VLBWI, the correlation between mainstream ETCO 2 and PaCO 2 is good, but the agreement is poor and negatively influenced by the severity of pulmonary disease. Capnography is feasible in ELBWI. ETCO 2 should not replace PaCO 2 measurements in ventilated VLBWI, but may have a role to detect trends of PaCO 2. Pediatr Pulmonol. 2012; 47:367-372.

KW - capnography

KW - carbon dioxide monitoring

KW - neonatal intensive care unit

KW - ventilation

KW - very low birth weight infants

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End-tidal carbon dioxide monitoring in very low birth weight infants: Correlation and agreement with arterial carbon dioxide

Abstract

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