Use of capnographs to assess quality of pediatric ventilation with 3 different airway modalities.
OBJECTIVE
Prehospital pediatric airway management is difficult and controversial. Options include bag-mask ventilation (BMV), endotracheal tube (ETT), and laryngeal mask airway (LMA). Emergency Medical Services personnel report difficulty assessing adequacy of BMV during transport. Capnography, and capnograph tracings in particular, provide a measure of real-time ventilation currently used in prehospital medicine but have not been well studied in pediatric patients or with BMV. Our objective was to compare pediatric capnographs created with 3 airway modalities.


METHODS
This was a prospective study of pediatric patients requiring ETT or LMA ventilation during elective surgical procedures. Data were collected during BMV using 2 bag types (flow-inflating and self-inflating). The ETT or LMA was placed and ventilation with each bag type repeated. Ten- to 14-second capnographs were reviewed by 2 blinded anesthesiologists who were asked to assess ventilation and identify the airway and bag type used. Descriptive statistics, κ, and risk ratios were calculated.


RESULTS
Twenty-nine patients were enrolled. Median age was 4.4 years (2 months to 16.8 years). One hundred sixteen capnographs were reviewed. Reviewers were unable to differentiate between airway modalities and agreed on adequacy of ventilation 77% of the time (κ = 0.6, P < .001). Bag-mask ventilation was rated inadequate more frequently than ETT or LMA ventilation. There were no difference between ETT and LMA ventilation and no difference between the 2 bag types.


CONCLUSIONS
Capnographs are generated during BMV and are virtually identical to those produced with ETT or LMA ventilation. Attention to capnographs could improve outcomes during emergency treatment and transport of critically ill pediatric patients requiring ventilation with any of these airway modalities.
University of Colorado Denver, Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, Aurora, CO. Electronic address: Julia.freeman@childrenscolorado.org.
Julia Fuzak
JF
Freeman
University of Colorado Denver, Department of Anesthesiology, Children's Hospital Colorado, Aurora, CO.
Christopher
C
Ciarallo
Denver Health Medical Center, Department of Emergency Medicine, Denver, CO.
Lara
L
Rappaport
University of Colorado Denver, Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, Aurora, CO.
Maria
M
Mandt
University of Colorado Denver, Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, Aurora, CO.
Lalit
L
Bajaj
D000293:Adolescent; D058109:Airway Management / Q000295:instrumentation* / Q000379:methods*; D019296:Capnography; D002648:Child; D002675:Child, Preschool; D017558:Elective Surgical Procedures; D004632:Emergency Medical Services; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D017214:Laryngeal Masks; D011446:Prospective Studies