title: Endtidal carbon dioxide monitoring in children with congenital heart disease during sedation for cardiac catheterization by nonanesthesiologists.
abstract: BACKGROUND
  This prospective observational study compared endtidal carbon dioxide (P(E)CO(2)) with blood gas carbon dioxide (PaCO(2)) values in children sedated by nonanesthesiologists for cardiac catheterization.
  
  
  METHODS
  A nasal cannula designed to obtain gas sampling simultaneously from over the mouth and nares was taped into place after assuring a good waveform. Patients' cardiac lesions, site of blood gas sampling and P(E)CO(2)were recorded.
  
  
  RESULTS
  Two hundred and one blood/P(E)CO(2) pairs were measured in 59 patients from 4 days to 18 years of age. Linear regression, Pearson correlation, and Bland-Altman analysis revealed a reasonable relationship (r = 0.493, P < 0.01, bivariate Pearson correlation) for all blood/expired CO(2) pairs even when the blood sample was obtained from an area of the circulation with shunting. There was no significant difference in the accuracy of the blood/P(E)CO(2) pairs between infants who weighed </=15 kg compared with children who weighed >15 kg. Thirteen children were diagnosed with partial or complete airway obstruction.
  
  
  CONCLUSIONS
  Endtidal CO(2) measurement provides a reasonable reflection of blood CO(2) values if the expired gas-sampling catheter is taped in place after assuring a good waveform. The veracity of the data was the same throughout the patient size range. Expired CO(2) monitoring is useful for assessing the adequacy of respirations and the patency of the airway in children 3-89 kg.
authors.affiliation: Harvard Medical School, Division of Pediatric Anesthesia, Department of Anesthesia and Critical Care Medicine, Massachusetts General Hospital, Boston MA 02114, USA. cjcote@partners.org
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Coté
authors.forename: David F
authors.initials: DF
authors.lastname: Wax
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Jennings
authors.forename: Carla L
authors.initials: CL
authors.lastname: Gorski
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kurczak-Klippstein
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction / Q000378:metabolism; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000032:analysis* / Q000097:blood; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood*; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D016343:Monitoring, Intraoperative
chemical_list: D002245:Carbon Dioxide