Use of capnography in the delivery room for assessment of endotracheal tube placement.
OBJECTIVE
Determine whether end-tidal CO(2) (ETCO(2)) monitoring allows for more rapid discrimination of tracheal versus esophageal intubation than standard clinical assessment during neonatal resuscitation in the delivery room.


METHODS
Endotracheal tube (ETT) placement was assessed using either a hand-held monitor that displayed graphic and quantitative ETCO(2) by an investigator not involved in the resuscitation, or using clinical parameters by the resuscitation team unaware of the ETCO(2) data. The time differences between ETCO(2) and clinical determinations of ETT placement were compared.


RESULTS
Capnography correctly identified all 16 tracheal and 11 esophageal intubations performed on 16 study infants. The median times (and range) in seconds required for capnographic and clinical determination of tracheal intubation were 9 (4 to 26) vs. 35 (18 to 70), p<.001, and for esophageal intubation were 9 (4 to 17) vs. 30 (25 to 111), p=.001.


CONCLUSIONS
Capnography allowed more rapid determination of both tracheal and unintended esophageal intubation than clinical assessment.
Repetto
J E
JE
Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Donohue PA-C
P K
PK
Baker
S F
SF
Kelly
L
L
Nogee
L M
LM
D001034:Apgar Score; D001724:Birth Weight; D019296:Capnography; D003696:Delivery Rooms; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000628:therapy*; D007442:Intubation, Intratracheal; D008297:Male; D011446:Prospective Studies; D012151:Resuscitation; D018570:Risk Assessment; D012680:Sensitivity and Specificity