End-tidal Carbon Dioxide and Transcutaneous Carbon Dioxide Monitoring During Neonatal Transport

¹ Royal Children's Hospital, Australia
² Newborn Emergency Transport Service (Victoria), Australia
³ Royal Women's Hospital, Australia

^* To whom correspondence should be addressed. E-mail: david.tingay{at}rch.org.au.

Accepted 22 April 2005

	Abstract

Objective:To assess the accuracy of end-tidal carbon dioxide during neonatal transport compared with arterial and transcutaneous measurements.

Design:Paired end-tidal and transcutaneous carbon dioxide recordings were measured frequently during road transport of 21 ventilated neonates . The first paired carbon dioxide (CO₂) values were compared with an arterial blood gas. The differences between arterial CO₂ (PaCO₂), transcutaneous CO₂ (PtcCO₂) and end-tidal CO₂ (PetCO₂) (P_{(a- Tc)}CO₂, P_(a-Et) CO₂ and P_(Tc-Et) CO₂) were analysed. The Bland-Altman method was used to assess bias and repeatability.

Results:PetCO₂ correlated strongly with PaCO₂ and PtcCO₂. However PetCO₂ underestimated PaCO₂ at a clinically unacceptable level (mean - 1.1 kPa [SD 0.70]) and did not trend reliably over time within individual subjects. The PetCO₂ bias was independent of the PaCO₂ and severity of lung disease. Conclusions: End-tidal CO₂ had an unacceptable underrecording bias. Transcutaneous CO₂ should, currently, be considered the preferred method of non-invasive CO₂ monitoring for neonatal transport.

Keywords: Carbon dioxide, infant, newborn, mechanical ventilation, patient monitoring, patient transport

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