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Capnography for ET Placement
Use of Capnography in the Delivery Room for Assessment of Endotracheal Tube Placement. Repetto JE, Donohue PK, Baker SF, et al. J Perinatol 2001; 21: 284-7.
Sixteen neonates who required endotracheal intubation as part of their delivery room resuscitation were included in the study. Endotracheal tube placement was assessed using an end-tidal CO2 (ETCO2) monitor by an investigator not involved in the resuscitation, and by clinical parameters by the resuscitation team who were unaware of the ETCO2 data. Capnography correctly identified all 16 tracheal and 11 esophageal intubations performed on the 16 study infants. The median times (and range) in seconds required for capnographic and clinical determinations of tracheal intubation were 9 (4-26) vs. 35 (18-70), p < 0.001, and for esophageal intubation were 9 (4-17) vs. 30 (25-111), p = 0.001.
Comment. Anesthesiologists have been using capnography for years to confirm ET tube placement, and there is little doubt of the accuracy of this technique. We now have good data that it also works in premature infants after delivery, and that it is significantly quicker than clinical assessment. Now I know that those of you who are experienced at intubation will protest that you don’t need an ETCO2 monitor to tell you that the tube is in the trachea. This study was done in a teaching center (Johns Hopkins Hospital in Baltimore) and pediatric residents or fellows did most of the intubations. The fact that there were 11 inadvertent esophageal intubations out of 16 infants in this study attests to the utility of this technique in the teaching setting. We should consider using ETCO2 monitoring as part of the clinical validation protocol in our NICUs when training and certifying residents, fellows, nurse practitioners, nurses and respiratory therapists to be able to intubate babies. We may also want to consider using ETCO2 monitoring to confirm tracheal placement of the ET tube prior to surfactant administration in the delivery room setting. Since a normal capnographic waveform does not preclude the possibility that the ET tube has been misplaced into a mainstem bronchus, your clinical evaluation of breath sounds is still necessary.
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