Capnometry as a predictor of admission in bronchiolitis
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Published on: January 8, 2019
Taher Lashkeri1, John M Howell, Rick Place
1Department of Emergency Medicine, Inova Fairfax Hospital for Children, Falls Church, VA, USA.
Insights
Capnometry readings do not reliably predict hospital admission for infants with bronchiolitis. This study found no significant differences in end-tidal CO2 levels between admitted and discharged children, or across different work of breathing scores.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Emergency Medicine
Background:
- Bronchiolitis is a common pediatric respiratory illness, often requiring hospitalization.
- Predicting clinical deterioration in bronchiolitis can be challenging for emergency department physicians.
- Capnometry, measuring end-tidal CO2 (ETCO2), is a non-invasive monitoring tool.
Purpose of the Study:
- To investigate if capnometry readings differ significantly between hospitalized and discharged bronchiolitis patients.
- To assess the utility of ETCO2 in predicting the need for admission in young children with bronchiolitis.
Main Methods:
- Prospective study of 105 children under 24 months with clinical bronchiolitis.
- Single ETCO2 measurement and work of breathing score recorded before treatment.
- Physicians were blinded to ETCO2 readings during clinical decision-making.
Main Results:
- No significant difference in ETCO2 readings between admitted (mean 32.6 mm Hg) and discharged (mean 31.4 mm Hg) children.
- ETCO2 levels were not significantly different across low, intermediate, and high work of breathing score groups.
- Receiver operating characteristic curve analysis did not show predictive value for admission.
Conclusions:
- Capnometry is not a useful tool for predicting hospital admission in infants with bronchiolitis.
- ETCO2 measurements do not correlate with the severity of work of breathing in this population.
Objectives:
Bronchiolitis is a dynamic condition, and predicting clinical deterioration can be difficult. The objective of this study was to determine whether capnometry readings among bronchiolitic children admitted to the hospital are significantly different from those discharged from the emergency department.
Methods:
We prospectively studied a convenience sample of children younger than 24 months with clinical bronchiolitis. A single end-tidal CO2 (ETCO2) reading was taken before treatment, and a clinical work of breathing score was assigned to each patient. Treating physicians and nurses were blinded to capnometry readings. The decision to admit was based on the judgment of the attending physician. Descriptive statistics and appropriate hypothesis testing were performed. A receiver operating characteristic curve was constructed for the association between admission and capnometry readings. The α was set at 0.05 for all comparisons.
Results:
One hundred five children with bronchiolitis were included for study. Capnometry readings for admitted (mean, 32.6 mm Hg; 95% confidence interval [CI], 30.3-34.9 mm Hg) and discharged (mean 31.4 mm Hg; 95% CI 29.8-33.0 mm Hg) bronchiolitic children were not significantly different. Capnometry readings for low (mean, 31.7 mm Hg; 95% CI, 29.5-33.8 mm Hg), intermediate (mean, 32.1 mm Hg; 95% CI, 30.1-34.1 mm Hg), and high (mean, 30.5 mm Hg; 95% CI, 19.3-41.7 mm Hg) work of breathing (score) ranges were not significantly different.
Conclusions:
Capnometry readings are not useful in predicting admission for children younger than 2 years with clinical bronchiolitis. There are no significant differences in capnometry readings among bronchiolitic children with low, medium, and high work of breathing scores.
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