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Noninvasive capnometry monitoring for respiratory status during pediatric seizures
T J Abramo1, R A Wiebe, S Scott
1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235-9063, USA.
Insights
Oral/nasal capnometry reliably measures end-tidal CO2 in pediatric seizure patients. This provides a dependable assessment of pulmonary status, aiding decisions on ventilatory support.
Area of Science:
- Pediatric critical care
- Respiratory monitoring
- Neurology
Background:
- Seizures in children can lead to respiratory compromise.
- Accurate monitoring of pulmonary status is crucial for timely intervention.
- End-tidal CO2 (ETCO2) is a non-invasive measure of ventilation.
Purpose of the Study:
- To evaluate the reliability and clinical utility of oral/nasal capnometry for ETCO2 monitoring in pediatric patients experiencing active seizures or in the post-ictal state.
- To compare ETCO2 measurements with capillary PCO2 and clinical observations.
Main Methods:
- A prospective, observational study was conducted with 166 pediatric patients (105 with active seizures, 61 post-ictal).
- Oral/nasal sidestream capnometry was used to obtain ETCO2 readings every 5 minutes for 60 minutes.
- ETCO2 values were compared against capillary PCO2 and clinical assessments, including respiratory rate, oxygen saturation, and pulse rate.
Main Results:
- A strong correlation was found between ETCO2 and capillary PCO2 (r2 = .97; p < .0001), with a mean bias of 0.33 torr.
- ETCO2 demonstrated a significant correlation with changes in respiratory rate (r2 = .22; p < .001), but a weaker correlation with oxygen saturation (r2 = .02; p = .01).
- Variability in ETCO2 measurements was not significantly related to age or respiratory rate ranges.
Conclusions:
- Oral/nasal capnometry provides dependable end-tidal CO2 measurements in pediatric patients with seizures.
- Continuous ETCO2 monitoring offers a reliable method for assessing pulmonary status, guiding decisions regarding ventilatory support.
Objective:
To determine the reliability and clinical value of end-tidal CO2 by oral/nasal capnometry for monitoring pediatric patients presenting post ictal or with active seizures.
Design:
Clinical, prospective, observational study.
Setting:
University affiliated children's hospital.
Interventions:
One hundred sixty-six patients (105 patients with active seizures, 61 post ictal patients) had end-tidal CO2 obtained by oral/nasal sidestream capnometry, and respiratory rates, oxygen saturation, and pulse rates recorded every 5 mins until 60 mins had elapsed. End-tidal CO2 values were compared with a capillary PCO2 and clinical observation.
Measurements And Main Results:
The mean end-tidal CO2 reading was 43.0 +/- 11.8 torr [5.7 +/- 1.6 kPa] and the mean capillary PCO2 reading was 43.4 +/- 11.7 torr [5.7 +/- 1.6 kPa]. The correlation between end-tidal CO2 and capillary PCO2 was significant (r2 = .97; p < .0001). A relative average bias of 0.33 torr (0.04 kPa) with end-tidal CO2 lower than capillary PCO2 was established with 95% limits of agreement +/-4.2 torr (+/-0.6 kPa). Variability of difference scores was not related to range of mean scores (r2 = .00003), age (r2 = .0004), or respiratory rates (r2 = .0009). End-tidal CO2 (r2 = .22; p < .001) correlated better with respiratory rate changes when compared with oxygen saturation (r2 = .02; p = .01).
Conclusions:
Dependable end-tidal CO2 values can be obtained in pediatric seizure patients using an oral/nasal cannula capnometry circuit. Continuous end-tidal CO2 monitoring provides the clinician with a reliable assessment of pulmonary status that can assist with decisions to provide ventilatory support.