Detection of exhaled carbon dioxide following intubation during resuscitation at delivery.

OBJECTIVES

End tidal carbon dioxide (ETCO) monitoring can facilitate identification of successful intubation. The aims of this study were to determine the time to detect ETCO following intubation during resuscitation of infants born prematurely and whether it differed according to maturity at birth or the Apgar scores (as a measure of the infant's condition after birth).

DESIGN

Analysis of recordings of respiratory function monitoring.

SETTING

Two tertiary perinatal centres.

PATIENTS

Sixty-four infants, with median gestational age of 27 (range 23-34)weeks.

INTERVENTIONS

Respiratory function monitoring during resuscitation in the delivery suite.

MAIN OUTCOME MEASURES

The time following intubation for ETCO levels to be initially detected and to reach 4 mm Hg and 15 mm Hg.

RESULTS

The median time for initial detection of ETCO following intubation was 3.7 (range 0-44) s, which was significantly shorter than the median time for ETCO to reach 4 mm Hg (5.3 (range 0-727) s) and to reach 15 mm Hg (8.1 (range 0-827) s) (both P<0.001). There were significant correlations between the time for ETCO to reach 4 mm Hg (r=-0.44, P>0.001) and 15 mm Hg (r=-0.48, P<0.001) and gestational age but not with the Apgar scores.

CONCLUSIONS

The time for ETCO to be detected following intubation in the delivery suite is variable emphasising the importance of using clinical indicators to assess correct endotracheal tube position in addition to ETCO monitoring. Capnography is likely to detect ETCO faster than colorimetric devices.