Introduction: We evaluated an EtCO2 device (Easy Cap, Nellcor-Puritan Bennett, Pleasanton, CA) for determining correct endotracheal tube (ET tube) placement in preterm and term neonates with respiratory failure. Methods: A purple indicator paper diaphragm was connected to the ET tube adapter (in-line with oxygen flow and a Mapleson apparatus), which turned yellow with CO2 exposure. Each infant was hand ventilated for 1 minute, and maximum color change recorded. Auscultation and chest roentenograms were performed to confirm ET placement within the tracha(through the thoracic inlet and above the carina). Sensitivity, specificity, positive and negative accuracies, false positive and false negative rates, and test utility were calculated. Results: Of 42 ETI episodes in 29 neonates (gestations 24-39 weeks, birth weights 630-4090 grams), 37 had positive color change with good ET position by chest roentenograms, 1 had positive color change with the ET tube positioned above the vocal cords, 2 had good ETT position but no color change, and 2 had esophageal intubations with no color change. Sensitivity was 0.95, specificity 0.67, positive predictive accuracy 0.97, negative predictive accuracy 0.50, false positive rate 0.03, false negative rate 0.50, and test utility 0.93. Conclusions: The EtCO2 device used in this study provided a relatively accurate, quick and inexpensive bedside assessment tool for endotracheal tube placement in a broad range of neonates. Subsequent confirmation by chest roentenography is recommended.
