Original Article
Quantitative End-Tidal Carbon Dioxide Monitoring in the Delivery Room: A Randomized Controlled Trial

Portions of this study were presented at the Pediatric Academic Societies' Meeting, April 30 - May 3, 2011, Denver, CO.
https://doi.org/10.1016/j.jpeds.2012.12.016Get rights and content

Objectives

To investigate the utility of continuous quantitative end-tidal CO2 (Etco2) monitoring for managing assisted ventilation in the delivery room (DR).

Study design

This is a prospective randomized controlled trial. Infants who received positive pressure ventilation (PPV) were randomized to a control versus a monitored arm. In the monitored arm, the resuscitating team adjusted PPV based on Etco2 values. In the control arm, the team provided PPV based on clinical assessment. Etco2 levels after resuscitation and admission Pco2 levels were compared between groups.

Results

Fifty infants were enrolled, and 48 subjects had primary outcome data. Of those, 7 infants were intubated in the DR, 41 infants received PPV via mask until respiratory support could be maintained on continuous positive airway pressure alone. The median Etco2 levels at the end of resuscitation were 44 mm Hg (16-66 mm Hg) in the control arm and 43 mm Hg (29-59 mm Hg) in the monitored arm. The proportion of Etco2 levels outside of the prespecified range was 52.6% (control) and 33.3% (monitored) (P = .236). The median admission Pco2 levels were 57 mm Hg (36-110 mm Hg) in the control arm and 55 mm Hg (40-93 mm Hg) in the monitored arm. The proportion of admission Pco2 levels outside of the prespecified range was 33.3% (control) versus 37.5% (monitored) (P = .763).

Conclusions

Etco2 monitoring in the DR did not reduce the proportion of admission Pco2 levels outside of the prespecified range in a population of infants supported mostly with noninvasive ventilation.

Section snippets

Methods

This is a prospective randomized controlled trial to evaluate the effectiveness of a quantitative Etco2 device at improving mechanical ventilation in the DR. The University of California, San Diego Medical Center institutional review board approved the trial, which was registered with ClinicalTrials.gov (NCT1381068). Antenatal consents were obtained from mothers admitted to the labor and delivery unit whose delivery was considered high risk for resuscitation.

All infants were born between

Results

The number of families approached for the study and randomization numbers are shown in Figure 2. The demographic characteristics were similar between groups (Table I). Most of the infants enrolled were <32 weeks' gestation (n = 38). None of the 12 infants ≥32 weeks were intubated in the DR. Of the 48 patients with primary outcome data, 19 complete Etco2 tracings were available in the control arm and 18 complete Etco2 tracings were available in the monitored arm. Eleven patients did not have

Discussion

The primary outcome of our study, the proportion of Pco2 levels outside of the targeted range, was not reduced significantly with Etco2 monitoring in the DR. This study was originally designed to evaluate Etco2 monitoring as a method of improving ventilation in intubated infants in the DR. Our practice shifted during the time period of the study toward less invasive ventilation. Therefore, the majority of subjects were treated with mask ventilation initially and CPAP alone by the end of

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  • Cited by (0)

    The authors declare no conflicts of interest.

    Study was registered with ClinicalTrials.gov: NCT1381068.

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