Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Effect of tidal volume and end tracheal tube leakage on end-tidal CO2 in very low birth weight infants

Journal of Perinatology volume 41, pages 47–52 (2021)Cite this article

Subjects

Abstract

Objective

To examine the extents to which low tidal volume (VT) and endotracheal tube (ETT) leakeage influence the accuracy of ETCO2 for estimating arterial PCO2 (PaCO2) in very low birth weight (VLBW) infants with mechanical ventilation.

Study design

An observational study. We evaluated a total of 287 paired ETCO2 and PaCO2 values as well as VTs obtained from 22 VLBW infants with ventilation. Deming regression, quadratic discriminant analysis, and Bland–Altman analysis were performed.

Result

ETCO2 and PaCO2 were correlated (r2 = 0.5897, p < 0.0001). A quadratic discrimination analysis of the VT and the percentage of leak yielded 70.4% [95%CI, 65.1 to 75.7] discrimination for the agreement between ETCO2 and PaCO2. ETCO2 was strongly correlated with PaCO2 in the discriminant function Z > 0 group (r2 = 0.7234, p < 0.0001).

Conclusion

Our results indicate that ETCO2 is a good surrogate for PaCO2 when VT is high and ETT leak is low.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Relationship and limits of agreement between ETCO2 and PaCO2 in VLBW infants.
Fig. 2: Scatter plot of the tidal volume versus the percentage of leak in VLBW infants.
Fig. 3

Similar content being viewed by others

References

  1. Erickson SJ, Grauaug A, Gurrin L, Swaminathan M. Hypocarbia in the ventilated preterm infant and its effect on intraventricular haemorrhage and bronchopulmonary dysplasia. J Paediatr Child Health. 2002;38:560–2.

    Article  CAS  Google Scholar 

  2. Giannakopoulou C, Korakaki E, Manoura A, Bikouvarakis S, Papageorgiou M, Gourgiotis D, et al. Significance of hypocarbia in the development of periventricular leukomalacia in preterm infants. Pediatr Int. 2004;46:268–73.

    Article  Google Scholar 

  3. Burton GW. The value of carbon dioxide monitoring during anaesthesia. Anaesthesia. 1966;21:173–83.

    Article  CAS  Google Scholar 

  4. Bhende MS. End-tidal carbon dioxide monitoring in pediatrics—clinical applications. J Postgrad Med. 2001;47:215–8.

    CAS  PubMed  Google Scholar 

  5. Salthe J, Kristiansen SM, Sollid S, Oglaend B, Soreide E. Capnography rapidly confirmed correct endotracheal tube placement during resuscitation of extremely low birthweight babies (<1000 g). Acta Anaesthesiol Scand. 2006;50:1033–6.

    Article  CAS  Google Scholar 

  6. Foy KE, Mew E, Cook TM, Bower J, Knight P, Dean S, et al. Paediatric intensive care and neonatal intensive care airway management in the United Kingdom: the PIC-NIC survey. Anaesthesia. 2018;73:1337–44.

    Article  CAS  Google Scholar 

  7. Takahashi D, Hiroma T, Nakamura T. PETCO2 measured by a new lightweight mainstream capnometer with very low dead space volume offers accurate and reliable noninvasive estimation of PaCO2. Res Rep. Neonatol. 2011;1:61–66.

    Google Scholar 

  8. Takahashi D, Matui M, Hiroma T, Nakamura T. A lightweight mainstream capnometer with very low dead space volume is useful monitor for neonates with spontanous and mechanical ventilation; Pilot study. Open J Pediatr. 2012;2:127–32.

  9. Riker JB, Haberman B. Expired gas monitoring by mass spectrometry in a respiratory intensive care unit. Crit Care Med. 1976;4:223–9.

    Article  CAS  Google Scholar 

  10. Geiser DR, Rohrbach BW. Use of end-tidal CO2 tension to predict arterial CO2 values in isoflurane-anesthetized equine neonates. Am J Vet Res. 1992;53:1617–21.

    CAS  PubMed  Google Scholar 

  11. Scrivens A, Zivanovic S, Roehr CC. Is waveform capnography reliable in neonates? Arch Dis Child. 2019;104:711–5.

    Article  Google Scholar 

  12. Kugelman A, Golan A, Riskin A, Shoris I, Ronen M, Qumqam N, et al. Impact of continuous capnography in ventilated neonates: a randomized, multicenter study. J Pediatr. 2016;168:e52.

    Article  Google Scholar 

  13. Thompson JE, Jaffe MB. Capnographic waveforms in the mechanically ventilated patient. Respir Care. 2005;50:100–8. discussion 108–9

    PubMed  Google Scholar 

  14. Tingay DG, Stewart MJ, Morley CJ. Monitoring of end tidal carbon dioxide and transcutaneous carbon dioxide during neonatal transport. Arch Dis Child Fetal Neonatal Ed. 2005;90:F523–526.

    Article  CAS  Google Scholar 

  15. Contencin P, Narcy P. Study Group for Neonatology and Pediatric Emergencies in the Parisian Area Size of endotracheal tube and neonatal acquired subglottic stenosis. Arch Otolaryngol Head Neck Surg. 1993;119:815–9.

    Article  CAS  Google Scholar 

  16. Deming WE. Statistical adjustment of data. NY: Dover Publications. Wiley; 1943.

    Google Scholar 

  17. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.

    Article  CAS  Google Scholar 

  18. Hastie T, Tibshirani R, Friedman J. The elements of statistical learning. NY: Springer; 2001.

    Book  Google Scholar 

  19. Motoyama EK, Davis PJ. Smith’s anesthesia for infants and children. 5th ed. St. Louis: CV Mosby, 1990.

  20. Fisher DM. Anesthesia equipment for pediatrics. Pediatric anesthesia, 4th Edn New York: Churchill Livingstone. 2001:207–8.

  21. Main E, Castle R, Stocks J, James I, Hatch D. The influence of endotracheal tube leak on the assessment of respiratory function in ventilated children. Intensive Care Med. 2001;27:1788–97.

    Article  CAS  Google Scholar 

  22. Wenzel U, Wauer RR, Wagner MH, Schmalisch G. In vitro and in vivo assessment of the Ventrak 1550/Capnogard 1265 for single breath carbon dioxide analysis in neonates. Br J Anaesth. 1999;83:503–10.

    Article  CAS  Google Scholar 

  23. Bernstein G, Knodel E, Heldt GP. Airway leak size in neonates and autocycling of three flow-triggered ventilators. Crit Care Med. 1995;23:1739–44.

    Article  CAS  Google Scholar 

  24. Mahmoud RA, Proquitte H, Fawzy N, Buhrer C, Schmalisch G. Tracheal tube airleak in clinical practice and impact on tidal volume measurement in ventilated neonates. Pediatr Crit Care Med. 2011;12:197–202.

    Article  Google Scholar 

  25. Schmalisch G, Al-Gaaf S, Proquitte H, Roehr CC. Effect of endotracheal tube leak on capnographic measurements in a ventilated neonatal lung model. Physiol Meas. 2012;33:1631–41.

    Article  CAS  Google Scholar 

  26. Greer KJ, Bowen WA, Krauss AN. End-tidal CO2 as a function of tidal volume in mechanically ventilated infants. Am J Perinatol. 2003;20:447–51.

    Article  Google Scholar 

  27. Vignaux L, Piquilloud L, Tourneux P, Jolliet P, Rimensberger PC. Neonatal and adult ICU ventilators to provide ventilation in neonates, infants, and children: a bench model study. Respir Care. 2014;59:1463–75.

    Article  Google Scholar 

  28. Kim P, Salazar A, Ross PA, Newth CJ, Khemani RG. Comparison of tidal volumes at the endotracheal tube and at the ventilator. Pediatr Crit Care Med. 2015;16:e324–331.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neonatology, Fukuda Hospital, Kumamoto, Japan

    Daijiro Takahashi & Koko Goto

  2. Division of Pediatrics, Fukuda Hospital, Kumamoto, Japan

    Daijiro Takahashi & Kei Goto

Authors
  1. Daijiro Takahashi
    View author publications

    Search author on:PubMed Google Scholar

  2. Koko Goto
    View author publications

    Search author on:PubMed Google Scholar

  3. Kei Goto
    View author publications

    Search author on:PubMed Google Scholar

Contributions

DT conceptualized and designed the study, designed the data collection instruments, collected data, carried out the initial analyses, drafted the initial manuscript, and reviewed and revised the manuscript. Koko G. designed the data collection instruments, collected data, and reviewed and revised the manuscript. Kei G. conceptualized and designed the study and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Daijiro Takahashi.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Takahashi, D., Goto, K. & Goto, K. Effect of tidal volume and end tracheal tube leakage on end-tidal CO2 in very low birth weight infants. J Perinatol 41, 47–52 (2021). https://doi.org/10.1038/s41372-020-0758-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41372-020-0758-2

This article is cited by

Search

Advanced search

Quick links