title: Resistance of Colorimetric Carbon Dioxide Detectors Commonly Utilized in Neonates.
abstract: BACKGROUND
  Colorimetric end-tidal carbon dioxide (ETCO2) detectors can identify airway obstruction during noninvasive ventilation and successful intubation during newborn resuscitation. The resistance of these devices is not well described, and the information provided by manufacturers is incomplete.
  
  
  METHODS
  We compared the resistance of 3 colorimetric ETCO2 detectors (Neo-StatCO2, Pedi-Cap, and Mini StatCO2,) and 2 mainstream capnograph sensors (EMMA infant airway adapter 17449 and neonatal/infant airway adapter YG-213T). Endotracheal tubes, 2.5-4.0-mm inner diameter (Portex) were measured as a reference range. A differential pressure transducer was placed between the device and a T-piece resuscitator. The other side of the device was open to air. Resistance to flow was tested at 1-10 L/min. Resistance was calculated as the change in pressure over change in flow and expressed as cm H2O/L/s.
  
  
  RESULTS
  There was a significantly higher mean resistance across all flows tested for the Neo-StatCO2 compared with the other ETCO2 devices (P < .001). There was a 6-fold difference between the least and most resistive colorimetric detectors. At the commonly utilized flow of 10 L/min, the resistance of the Neo-StatCO2 was 61.1 cm H2O/L/s, comparable with that of a 3.0 endotracheal tube, which we measured at 62.7 cm H2O/L/s. The resistance values of the Pedi-Cap and Mini StatCO2 were 9.9 and 8.4 cm H2O/L/s, respectively. Those of the EMMA and YG-213T were 7.1 and 2.6 cm H2O/L/s, respectively.
  
  
  CONCLUSIONS
  We found significant differences in resistance between devices used to detect ETCO2 during resuscitation of premature infants. Future trials are needed to determine the effects of this resistance on work of breathing, particularly on very premature newborns receiving mask CPAP.
authors.affiliation: Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California. melissa.brown@sharp.com.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Brown
authors.affiliation: Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California.
authors.forename: Danielle V
authors.initials: DV
authors.lastname: Lazarus
authors.affiliation: Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California.
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Gonzales
authors.affiliation: Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California.
authors.forename: Wade D
authors.initials: WD
authors.lastname: Rich
authors.affiliation: Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California.
authors.forename: Madeline J
authors.initials: MJ
authors.lastname: Wozniak
authors.affiliation: Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California.
authors.forename: Debra M
authors.initials: DM
authors.lastname: Poeltler
authors.affiliation: Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California.
authors.forename: Anup C
authors.initials: AC
authors.lastname: Katheria
mesh_terms: D000402:Airway Obstruction / Q000175:diagnosis* / Q000209:etiology; D019296:Capnography / Q000295:instrumentation*; D002245:Carbon Dioxide / Q000032:analysis; D003124:Colorimetry / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology; D007442:Intubation, Intratracheal; D008297:Male; D009359:Neonatology / Q000295:instrumentation*; D012119:Respiration; D012121:Respiration, Artificial / Q000009:adverse effects; D012151:Resuscitation / Q000295:instrumentation* / Q000379:methods; D013990:Tidal Volume
chemical_list: D002245:Carbon Dioxide
keywords: capnography; carbon dioxide detector; colorimetric; continuous positive airway pressure; infant; neonatal intensive care; newborn; resistance; resuscitation; work of breathing