Background: Assessing the ventilatory status of non-intubated infants in the Pediatric Intensive Care Unit (PICU) is\na constant challenge. Methods to evaluate ventilation include arterial blood gas analysis (ABG), which is invasive\nand intermittent, and transcutaneous carbon dioxide monitoring (PtcCO2), which, while non-invasive, is also intermittent.\nA method that is non-invasive and continuous would be of great benefit in this population. We hypothesized that\nnon-invasive capnometry via sidestream monitoring of exhaled carbon dioxide (CO2) would provide an acceptable\nmeasurement of ventilatory status when compared to ABG or PtcCO2.\nMethods: Preliminary prospective study of infants less than one year of age admitted to the PICU in a large urban\nteaching hospital. Infants not intubated and not requiring non-invasive ventilation were eligible. A sidestream CO2\nreading was obtained in a convenience sample of 39 patients. A simultaneous ABG was collected in those with an\narterial catheter, and a PtcCO2 was obtained in those without.\nResults: Correlation of sidestream CO2 with ABG was excellent (r2 = 0.907). Sidestream correlated less well with PtcCO2\n(r2 = 0.649). Results were not significantly altered when weight and respiratory rate were added as independent\nvariables. Bland-Altman analysis revealed a bias of -2.7 with a precision of �±6.5 when comparing sidestream CO2 to\nABG, and a bias of -1.7 with a precision of �±9.9 when comparing sidestream CO2 to PtcCO2.\nConclusions: Performance of sidestream monitoring of exhaled CO2 is acceptable clinical trending to assess the\neffectiveness of ventilation in non-intubated infants in the PICU
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