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At-home end-tidal carbon dioxide measurement in children with invasive home mechanical ventilation
Carolyn C Foster1,2,3, Soyang Kwon2, Avani V Shah4,5
1Department of Pediatrics, Division of Advanced General Pediatrics and Primary Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Insights
A portable capnograph device for measuring end-tidal carbon dioxide (EtCO2) is feasible for home use in children on mechanical ventilation. This innovation offers a viable option for monitoring EtCO2 at home, improving chronic care management.
Area of Science:
- Pediatric Pulmonology
- Biomedical Engineering
- Respiratory Care
Background:
- End-tidal carbon dioxide (EtCO2) monitoring is crucial for managing children with invasive home mechanical ventilation (HMV).
- Current options for at-home EtCO2 monitoring are limited, posing challenges for chronic care.
- A portable endotracheal capnograph (PEC) was developed to address this gap.
Purpose of the Study:
- To evaluate the feasibility and acceptability of a portable endotracheal capnograph (PEC) for home use in children requiring invasive home mechanical ventilation (HMV).
- To assess the accuracy and reliability of the PEC by comparing its measurements to established in-clinic devices.
Main Methods:
- Internal consistency of the PEC was assessed using intraclass correlation coefficients.
- Pearson's correlation and Bland-Altman analysis were used to compare PEC EtCO2 values with concurrent in-clinic EtCO2 and transcutaneous CO2 (TCM) measurements.
- Usability and acceptability were evaluated through qualitative interviews and surveys with family-caregivers at home.
Main Results:
- The PEC demonstrated high internal consistency (ICC=0.95).
- Correlations with in-clinic EtCO2 devices were strong (r=0.85, mean difference -3.8 mmHg) and with TCM devices (r=0.92, mean difference 0.2 mmHg).
- Family-caregivers successfully used the PEC at home for awake and sleeping children.
Conclusions:
- The portable endotracheal capnograph (PEC) is a feasible and acceptable device for home monitoring of EtCO2 in children with invasive HMV.
- Its measurements correlate well with existing clinical standards.
- This device has the potential to significantly improve the chronic management of pediatric patients on HMV by enabling reliable home monitoring.
Background:
Carbon dioxide concentration trending is used in chronic management of children with invasive home mechanical ventilation (HMV) in clinical settings, but options for end-tidal carbon dioxide (EtCO2 ) monitoring at home are limited. We hypothesized that a palm-sized, portable endotracheal capnograph (PEC) that measures EtCO2 could be adapted for in-home use in children with HMV.
Methods:
We evaluated the internal consistency of the PEC by calculating an intraclass correlation coefficient of three back-to-back breaths by children (0-17 years) at baseline health in the clinic. Pearson's correlation was calculated for PEC EtCO2 values with concurrent mean values of in-clinic EtCO2 and transcutaneous CO2 (TCM) capnometers. The Bland-Altman test determined their level of agreement. Qualitative interviews and surveys assessed usability and acceptability by family-caregivers at home.
Results:
CO2 values were collected in awake children in varied activity levels and positions (N = 30). The intraclass correlation coefficient for the PEC was 0.95 (p < 0.05). The correlation between the PEC and in-clinic EtCO2 device was 0.85 with a mean difference of -3.8 mmHg and precision of ±1.1 mmHg. The correlation between the PEC and the clinic TCM device was 0.92 with a mean difference of 0.2 mmHg and precision of ±1.0. Family-caregivers (N = 10) trialed the PEC at home; all were able to obtain measurements at home while children were awake and sometimes asleep.
Conclusions:
A portable, noninvasive device for measuring EtCO2 was feasible and acceptable, with values that trend similarly to currently in-practice, outpatient models. These devices may facilitate monitoring of EtCO2 at home in children with invasive HMV.
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