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Anne Greenough - One of the best experts on this subject based on the ideXlab platform.
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End-tidal Capnography monitoring in infants ventilated on the neonatal intensive care unit
Journal of Perinatology, 2021Co-Authors: Emma Williams, Theodore Dassios, Niamh O’reilly, Alison Walsh, Anne GreenoughAbstract:Objective To assess whether end-tidal Capnography (EtCO_2) monitoring reduced the magnitude of difference in carbon dioxide (CO_2) levels and the number of blood gases in ventilated infants. Study design A case–control study of a prospective cohort ( n = 36) with Capnography monitoring and matched historical controls ( n = 36). Result The infants had a median gestational age of 31.6 weeks. A reduction in the highest CO_2 level on day 1 after birth was observed after the introduction of EtCO_2 monitoring ( p = 0.043). There was also a reduction in the magnitude of difference in CO_2 levels on days 1 ( p = 0.002) and 4 ( p = 0.049) after birth. There was no significant difference in the number of blood gases. Conclusion Continuous end-tidal Capnography monitoring in ventilated infants was associated with a reduction in the degree of the magnitude of difference in CO_2 levels and highest level of CO_2 on the first day after birth.
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g552 assessment of continuous side stream end tidal Capnography monitoring on the neonatal intensive care unit
Archives of Disease in Childhood, 2020Co-Authors: Emma Williams, Theodore Dassios, Anne GreenoughAbstract:Background End tidal Capnography (EtCO2) provides a non-invasive form of continuous monitoring, but there have been concerns about its reliability on the neonatal unit. Our aim was to evaluate a novel side-stream capnograph device against gold standard mainstream Capnography and in ventilated infants with differing respiratory disease severities. Methods A prospective study of ventilated infants was undertaken. Simultaneous measurements of EtCO2 were made using a gold standard mainstream capnograph and the newer side-stream device (microstream Capnography). The side-stream results were also compared to arterial or capillary CO2 (PCO2) results. Respiratory disease severity was classified according to the ratio of dead space to tidal volume (Vd/Vt), which was calculated using the modified Bohr’s equation. Agreement between the results of the mainstream and side-stream device were assessed by Bland-Altman analysis with linear regression and Spearman’s rank correlation used to evaluate the strength of relationships. Ethical approval was given by the London (Camden & King’s Cross) Research Ethics Committee and parents gave informed written consent for their infants to take part in the study. Results Fifty-four infants (28 male) were recruited with a median (IQR) gestational age of 31.6 (28.1–36.6) weeks and a birthweight of 1.43 (0.91–2.66) kg. There was a strong correlation between the results of the mainstream and side-stream devices (r=0.93; p 0.35, r2=0.35; p=0.002). Conclusion Side-stream Capnography performed similarly to the gold standard mainstream Capnography. The relationship of EtCO2 to arterial or capillary CO2 levels diverged with increasing respiratory disease severity, likely as a result of a higher physiological dead space and greater ventilation perfusion mismatch.
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assessment of sidestream end tidal Capnography in ventilated infants on the neonatal unit
Pediatric Pulmonology, 2020Co-Authors: E J Williams, Theodore Dassios, Anne GreenoughAbstract:OBJECTIVES: Continuous monitoring of carbon dioxide (CO2 ) levels can be achieved by Capnography. Our aims were to compare the performance of a sidestream capnograph with a low dead space and sampling rate to a mainstream device and evaluate whether its results correlated with arterial/capillary CO2 levels in infants with different respiratory disease severities. WORKING HYPOTHESES: End-tidal carbon dioxide (EtCO2 ) results by sidestream and mainstream Capnography would correlate, but the divergence of EtCO2 and CO2 results would occur in more severe lung disease. STUDY DESIGN: Prospective cohort study. PATIENT-SUBJECT SELECTION: Fifty infants with a median (interquartile range) gestational age of 31.1 (27.1-37.4) weeks and birth weight of 1.37 (0.76-2.95) kg. METHODOLOGY: Concurrent measurements of EtCO2 in ventilated infants were made using a new Microstream sidestream device and a mainstream capnograph (gold standard). Results from both devices were compared with arterial or capillary CO2 levels. The ratio of dead space to tidal volume (Vd/Vt) was calculated to assess respiratory disease severity. RESULTS: The mean difference between the concurrent measurements of EtCO2 was -0.54 ± 0.67 kPa (95% agreement levels - 1.86 to 0.77 kPa), the correlation between the two was r = .85 (P 0.35; r2 = .33, P = .01) lung disease. CONCLUSIONS: The sidestream Capnography performed similarly to the mainstream Capnography. The poorer correlation of EtCO2 to PCO2 levels in infants with severe respiratory disease should highlight to clinicians increased ventilation-perfusion mismatch.
Theodore Dassios - One of the best experts on this subject based on the ideXlab platform.
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End-tidal Capnography monitoring in infants ventilated on the neonatal intensive care unit
Journal of Perinatology, 2021Co-Authors: Emma Williams, Theodore Dassios, Niamh O’reilly, Alison Walsh, Anne GreenoughAbstract:Objective To assess whether end-tidal Capnography (EtCO_2) monitoring reduced the magnitude of difference in carbon dioxide (CO_2) levels and the number of blood gases in ventilated infants. Study design A case–control study of a prospective cohort ( n = 36) with Capnography monitoring and matched historical controls ( n = 36). Result The infants had a median gestational age of 31.6 weeks. A reduction in the highest CO_2 level on day 1 after birth was observed after the introduction of EtCO_2 monitoring ( p = 0.043). There was also a reduction in the magnitude of difference in CO_2 levels on days 1 ( p = 0.002) and 4 ( p = 0.049) after birth. There was no significant difference in the number of blood gases. Conclusion Continuous end-tidal Capnography monitoring in ventilated infants was associated with a reduction in the degree of the magnitude of difference in CO_2 levels and highest level of CO_2 on the first day after birth.
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g552 assessment of continuous side stream end tidal Capnography monitoring on the neonatal intensive care unit
Archives of Disease in Childhood, 2020Co-Authors: Emma Williams, Theodore Dassios, Anne GreenoughAbstract:Background End tidal Capnography (EtCO2) provides a non-invasive form of continuous monitoring, but there have been concerns about its reliability on the neonatal unit. Our aim was to evaluate a novel side-stream capnograph device against gold standard mainstream Capnography and in ventilated infants with differing respiratory disease severities. Methods A prospective study of ventilated infants was undertaken. Simultaneous measurements of EtCO2 were made using a gold standard mainstream capnograph and the newer side-stream device (microstream Capnography). The side-stream results were also compared to arterial or capillary CO2 (PCO2) results. Respiratory disease severity was classified according to the ratio of dead space to tidal volume (Vd/Vt), which was calculated using the modified Bohr’s equation. Agreement between the results of the mainstream and side-stream device were assessed by Bland-Altman analysis with linear regression and Spearman’s rank correlation used to evaluate the strength of relationships. Ethical approval was given by the London (Camden & King’s Cross) Research Ethics Committee and parents gave informed written consent for their infants to take part in the study. Results Fifty-four infants (28 male) were recruited with a median (IQR) gestational age of 31.6 (28.1–36.6) weeks and a birthweight of 1.43 (0.91–2.66) kg. There was a strong correlation between the results of the mainstream and side-stream devices (r=0.93; p 0.35, r2=0.35; p=0.002). Conclusion Side-stream Capnography performed similarly to the gold standard mainstream Capnography. The relationship of EtCO2 to arterial or capillary CO2 levels diverged with increasing respiratory disease severity, likely as a result of a higher physiological dead space and greater ventilation perfusion mismatch.
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assessment of sidestream end tidal Capnography in ventilated infants on the neonatal unit
Pediatric Pulmonology, 2020Co-Authors: E J Williams, Theodore Dassios, Anne GreenoughAbstract:OBJECTIVES: Continuous monitoring of carbon dioxide (CO2 ) levels can be achieved by Capnography. Our aims were to compare the performance of a sidestream capnograph with a low dead space and sampling rate to a mainstream device and evaluate whether its results correlated with arterial/capillary CO2 levels in infants with different respiratory disease severities. WORKING HYPOTHESES: End-tidal carbon dioxide (EtCO2 ) results by sidestream and mainstream Capnography would correlate, but the divergence of EtCO2 and CO2 results would occur in more severe lung disease. STUDY DESIGN: Prospective cohort study. PATIENT-SUBJECT SELECTION: Fifty infants with a median (interquartile range) gestational age of 31.1 (27.1-37.4) weeks and birth weight of 1.37 (0.76-2.95) kg. METHODOLOGY: Concurrent measurements of EtCO2 in ventilated infants were made using a new Microstream sidestream device and a mainstream capnograph (gold standard). Results from both devices were compared with arterial or capillary CO2 levels. The ratio of dead space to tidal volume (Vd/Vt) was calculated to assess respiratory disease severity. RESULTS: The mean difference between the concurrent measurements of EtCO2 was -0.54 ± 0.67 kPa (95% agreement levels - 1.86 to 0.77 kPa), the correlation between the two was r = .85 (P 0.35; r2 = .33, P = .01) lung disease. CONCLUSIONS: The sidestream Capnography performed similarly to the mainstream Capnography. The poorer correlation of EtCO2 to PCO2 levels in infants with severe respiratory disease should highlight to clinicians increased ventilation-perfusion mismatch.
Jenifer R Lightdale - One of the best experts on this subject based on the ideXlab platform.
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patient safety during procedural sedation using Capnography monitoring a systematic review and meta analysis
BMJ Open, 2017Co-Authors: Rhodri Saunders, Michael L. Mestek, Jenifer R Lightdale, Michel Struys, Richard F PollockAbstract:Objective To evaluate the effect of Capnography monitoring on sedation-related adverse events during procedural sedation and analgesia (PSA) administered for ambulatory surgery relative to visual assessment and pulse oximetry alone. Design and setting Systematic literature review and random effects meta-analysis of randomised controlled trials (RCTs) reporting sedation-related adverse event incidence when adding Capnography to visual assessment and pulse oximetry in patients undergoing PSA during ambulatory surgery in the hospital setting. Searches for eligible studies published between 1 January 1995 and 31 December 2016 (inclusive) were conducted in PubMed, the Cochrane Library and EMBASE without any language constraints. Searches were conducted in January 2017, screening and data extraction were conducted by two independent reviewers, and study quality was assessed using a modified Jadad scale. Interventions Capnography monitoring relative to visual assessment and pulse oximetry alone. Primary and secondary outcome measures Predefined endpoints of interest were desaturation/hypoxaemia (the primary endpoint), apnoea, aspiration, bradycardia, hypotension, premature procedure termination, respiratory failure, use of assisted/bag-mask ventilation and death during PSA. Results The literature search identified 1006 unique articles, of which 13 were ultimately included in the meta-analysis. Addition of Capnography to visual assessment and pulse oximetry was associated with a significant reduction in mild (risk ratio (RR) 0.77, 95% CI 0.67 to 0.89) and severe (RR 0.59, 95% CI 0.43 to 0.81) desaturation, as well as in the use of assisted ventilation (OR 0.47, 95% CI 0.23 to 0.95). No significant differences in other endpoints were identified. Conclusions Meta-analysis of 13 RCTs published between 2006 and 2016 showed a reduction in respiratory compromise (from respiratory insufficiency to failure) during PSA with the inclusion of Capnography monitoring. In particular, use of Capnography was associated with less mild and severe oxygen desaturation, which may have helped to avoid the need for assisted ventilation.
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microstream Capnography improves patient monitoring during moderate sedation a randomized controlled trial
Pediatrics, 2006Co-Authors: Jenifer R Lightdale, Donald A Goldmann, Henry A Feldman, Adrienne Newburg, James A Dinardo, Victor L FoxAbstract:BACKGROUND. Investigative efforts to improve monitoring during sedation for patients of all ages are part of a national agenda for patient safety. According to the Institute of Medicine, recent technological advances in patient monitoring have contributed to substantially decreased mortality for people receiving general anesthesia in operating room settings. Patient safety has not been similarly targeted for the several million children annually in the United States who receive moderate sedation without endotracheal intubation. Critical event analyses have documented that hypoxemia secondary to depressed respiratory activity is a principal risk factor for near misses and death in this population. Current guidelines for monitoring patient safety during moderate sedation in children call for continuous pulse oximetry and visual assessment, which may not detect alveolar hypoventilation until arterial oxygen desaturation has occurred. Microstream Capnography may provide an “early warning system” by generating real-time waveforms of respiratory activity in nonintubated patients. OBJECTIVE. The aim of this study was to determine whether intervention based on Capnography indications of alveolar hypoventilation reduces the incidence of arterial oxygen desaturation in nonintubated children receiving moderate sedation for nonsurgical procedures. PARTICIPANTS AND METHODS. We included 163 children undergoing 174 elective gastrointestinal procedures with moderate sedation in a pediatric endoscopy unit in a randomized, controlled trial. All of the patients received routine care, including 2-L supplemental oxygen via nasal cannula. Investigators, patients, and endoscopy staff were blinded to additional Capnography monitoring. In the intervention arm, trained independent observers signaled to clinical staff if capnograms indicated alveolar hypoventilation for >15 seconds. In the control arm, observers signaled if capnograms indicated alveolar hypoventilation for >60 seconds. Endoscopy nurses responded to signals in both arms by encouraging patients to breathe deeply, even if routine patient monitoring did not indicate a change in respiratory status. OUTCOME MEASURES. Our primary outcome measure was patient arterial oxygen desaturation defined as a pulse oximetry reading of 5 seconds. Secondary outcome measures included documented assessments of abnormal ventilation, termination of the procedure secondary to concerns for patient safety, as well as other more rare adverse events including need for bag-mask ventilation, sedation reversal, or seizures. RESULTS. Children randomly assigned to the intervention arm were significantly less likely to experience arterial oxygen desaturation than children in the control arm. Two study patients had documented adverse events, with no procedures terminated for patient safety concerns. Intervention and control patients did not differ in baseline characteristics. Endoscopy staff documented poor ventilation in 3% of all procedures and no apnea. Capnography indicated alveolar hypoventilation during 56% of procedures and apnea during 24%. We found no change in magnitude or statistical significance of the intervention effect when we adjusted the analysis for age, sedative dose, or other covariates. CONCLUSIONS. The results of this controlled effectiveness trial support routine use of microstream Capnography to detect alveolar hypoventilation and reduce hypoxemia during procedural sedation in children. In addition, Capnography allowed early detection of arterial oxygen desaturation because of alveolar hypoventilation in the presence of supplemental oxygen. The current standard of care for monitoring all patients receiving sedation relies overtly on pulse oximetry, which does not measure ventilation. Most medical societies and regulatory organizations consider moderate sedation to be safe but also acknowledge serious associated risks, including suboptimal ventilation, airway obstruction, apnea, hypoxemia, hypoxia, and cardiopulmonary arrest. The results of this controlled trial suggest that microstream Capnography improves the current standard of care for monitoring sedated children by allowing early detection of respiratory compromise, prompting intervention to minimize hypoxemia. Integrating Capnography into patient monitoring protocols may ultimately improve the safety of nonintubated patients receiving moderate sedation.
Emma Williams - One of the best experts on this subject based on the ideXlab platform.
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End-tidal Capnography monitoring in infants ventilated on the neonatal intensive care unit
Journal of Perinatology, 2021Co-Authors: Emma Williams, Theodore Dassios, Niamh O’reilly, Alison Walsh, Anne GreenoughAbstract:Objective To assess whether end-tidal Capnography (EtCO_2) monitoring reduced the magnitude of difference in carbon dioxide (CO_2) levels and the number of blood gases in ventilated infants. Study design A case–control study of a prospective cohort ( n = 36) with Capnography monitoring and matched historical controls ( n = 36). Result The infants had a median gestational age of 31.6 weeks. A reduction in the highest CO_2 level on day 1 after birth was observed after the introduction of EtCO_2 monitoring ( p = 0.043). There was also a reduction in the magnitude of difference in CO_2 levels on days 1 ( p = 0.002) and 4 ( p = 0.049) after birth. There was no significant difference in the number of blood gases. Conclusion Continuous end-tidal Capnography monitoring in ventilated infants was associated with a reduction in the degree of the magnitude of difference in CO_2 levels and highest level of CO_2 on the first day after birth.
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g552 assessment of continuous side stream end tidal Capnography monitoring on the neonatal intensive care unit
Archives of Disease in Childhood, 2020Co-Authors: Emma Williams, Theodore Dassios, Anne GreenoughAbstract:Background End tidal Capnography (EtCO2) provides a non-invasive form of continuous monitoring, but there have been concerns about its reliability on the neonatal unit. Our aim was to evaluate a novel side-stream capnograph device against gold standard mainstream Capnography and in ventilated infants with differing respiratory disease severities. Methods A prospective study of ventilated infants was undertaken. Simultaneous measurements of EtCO2 were made using a gold standard mainstream capnograph and the newer side-stream device (microstream Capnography). The side-stream results were also compared to arterial or capillary CO2 (PCO2) results. Respiratory disease severity was classified according to the ratio of dead space to tidal volume (Vd/Vt), which was calculated using the modified Bohr’s equation. Agreement between the results of the mainstream and side-stream device were assessed by Bland-Altman analysis with linear regression and Spearman’s rank correlation used to evaluate the strength of relationships. Ethical approval was given by the London (Camden & King’s Cross) Research Ethics Committee and parents gave informed written consent for their infants to take part in the study. Results Fifty-four infants (28 male) were recruited with a median (IQR) gestational age of 31.6 (28.1–36.6) weeks and a birthweight of 1.43 (0.91–2.66) kg. There was a strong correlation between the results of the mainstream and side-stream devices (r=0.93; p 0.35, r2=0.35; p=0.002). Conclusion Side-stream Capnography performed similarly to the gold standard mainstream Capnography. The relationship of EtCO2 to arterial or capillary CO2 levels diverged with increasing respiratory disease severity, likely as a result of a higher physiological dead space and greater ventilation perfusion mismatch.
Arieh Riskin - One of the best experts on this subject based on the ideXlab platform.
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Impact of Continuous Capnography in Ventilated Neonates: A Randomized, Multicenter Study
The Journal of pediatrics, 2015Co-Authors: Amir Kugelman, David Bader, Irit Shoris, Arieh Riskin, Agenta Golan, Michal Ronen, Nelly Qumqam, Ruben BromikerAbstract:Objective To compare the time spent within a predefined safe range of CO 2 (30-60 mmHg) during conventional ventilation between infants who were monitored with distal end-tidal CO 2 (dETCO 2 , or Capnography) and those who were not. Study design For this randomized, controlled multicenter study, ventilated infants with a double-lumen endotracheal tube were randomized to 1 of 2 groups: the open (monitored) group, in which data from the capnograph were recorded, displayed to the medical team, and used for patient care, and the masked group, in which data from the capnograph were recorded. However, the measurements were masked and not available for patient care. dETCO 2 was compared with PaCO 2 measurements recorded for patient care. Results Fifty-five infants (25 open, 30 masked) participated in the study (median gestational age, 28.6 weeks; range, 23.5-39.0 weeks). The 2 groups were comparable. dETCO 2 was in good correlation ( r = 0.73; P 2 . Compared with infants in the masked group, those in the monitored group had significantly ( P = .03) less time with an unsafe dETCO 2 level (high: 3.8% vs 8.8% or low: 3.8% vs 8.9%). The prevalence of intraventricular hemorrhage or periventricular leukomalacia rate was lower in the monitored group ( P = .02) and was significantly ( P 2 monitoring and gestational age. Conclusion Continuous dETCO 2 monitoring improved control of CO 2 levels within a safe range during conventional ventilation in a neonatal intensive care unit. Trial registration ClinicalTrials.gov: NCT01572272.
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A novel method of distal end-tidal CO2 Capnography in intubated infants: comparison with arterial CO2 and with proximal mainstream end-tidal CO2.
Pediatrics, 2008Co-Authors: Amir Kugelman, Dana Zeiger-aginsky, David Bader, Irit Shoris, Arieh RiskinAbstract:OBJECTIVE. The objective of this study was to evaluate a novel method of distal end-tidal CO2 Capnography by comparison with Paco2 and with the more standard method that measures mainstream proximal end-tidal CO2 in intubated infants. METHODS. Included in the study were all infants who were ventilated with conventional mechanical ventilation and intubated with a double-lumen endotracheal tube in our NICU during the study period. Data were collected prospectively from 2 capnographs simultaneously and compared with Paco2. Sidestream distal end-tidal CO2 was measured by a Microstream capnograph via the extra port of a double-lumen endotracheal tube. Mainstream proximal end-tidal CO2 was measured via capnograph connected to the endotracheal tube. RESULTS. Twenty-seven infants (median [range] birth-weight: 1835 [490–4790] g; gestational age: 32.5 [24.8–40.8] weeks) participated in the study. We used for analysis 222 and 212 measurements of distal end-tidal CO2 and proximal end-tidal CO2, respectively. Distal compared with proximal end-tidal CO2 had a better correlation with Paco2 and a better agreement with Paco2. The accuracy of distal end-tidal CO2 decreased, but it remained a useful measure of Paco2 in the high range of Paco2 (≥60 mmHg) or in conditions of severe lung disease. A subanalysis for infants who weighed CONCLUSIONS. Distal end-tidal CO2 measured via a double-lumen endotracheal tube was found to have good correlation and agreement with Paco2, remained reliable in conditions of severe lung disease, and was more accurate than the standard mainstream proximal end-tidal CO2.
