Accuracy of a new low-flow sidestream capnography technology in newborns: A pilot study

Abstract

Objective: To evaluate the accuracy of a new low-flow sidestream capnography technology and analyze components of the capnogram in mechanically ventilated newborns with and without pulmonary disease. Methods: Twenty patients were prospectively identified. Eligible infants were mechanically ventilated and had an indwelling arterial catheter. Two groups were identified: newborns who were receiving mechanical ventilation for pulmonary diseases, and newborns who were receiving postoperative mechanical ventilation for nonpulmonary conditions. End-tidal CO2 (PetCO2) was measured for 1-minute pre- and post-arterial blood sampling, and PetCO2 and PaCO2 were compared for each patient. Eight quantitative waveform parameters were also measured on all patients. Results: Newborns in the pulmonary group (n = 13) (persistent pulmonary hypertension of the newborn/meconium aspiration syndrome, respiratory distress syndrome, pneumonia) and newborns in the control group (n = 7) were matched for birth weight, gestational age, and postnatal age. PetCO2-PaCO2 Gradient values were higher in the pulmonary group (7.4 ± 3.3 mm Hg) than controls (3.4 ± 2.4 mm Hg). Four waveform parameters (ascending slope, alveolar angle, alpha angle, descending angle) were identified, which independently differentiated patients with pulmonary disease from controls. Conclusions: Low-flow capnography with Microstream technology accurately measured alveolar CO2 in newborns without pulmonary disease, as demonstrated by normal PetCO2-PaCO2 gradients. The measured PetCO2-PaCO2 gradient, as expected, was significantly higher in newborns with pulmonary disease. We also identified four quantitative waveform parameters that may be useful in differentiating between mechanically ventilated newborn patients with and without lung disease.