Klin Padiatr 2022; 234(01): 26-32
DOI: 10.1055/a-1546-1473
Original Article

Can Non-Invasive Capnography and Integrated Pulmonary Index Contribute to Patient Monitoring in the Pediatric Emergency Department?

Können nicht-invasive Kapnographie und integrierter Lungenindex zur Patientenüberwachung in der pädiatrischen Notaufnahme beitragen?
Ramazan Gurlu
Pediatrics, Emergency Care Unit, Akdeniz University, Antalya, Turkey
,
Pediatrics, Emergency Care Unit, Akdeniz University, Antalya, Turkey
,
Omer Baspinar
Pediatrics, Emergency Care Unit, Akdeniz University, Antalya, Turkey
,
Nilgun Erkek
Pediatrics, Emergency Care Unit, Akdeniz University, Antalya, Turkey
› Author Affiliations

Abstract

Objectives Noninvasive capnography (NICG) devices can measure oxygen saturation, end-tidal carbon dioxide (EtCO2), respiratory rate, heart rate values and integrated pulmonary index (IPI). This study aimed to evaluate patients who were monitored using NICG for various indications in a pediatric emergency department and to determine its contribution to patient management in the pediatric emergency department (PED).

Methods In this study, children aged <18 years who had been monitored with a NICG at the PED in our university between August 2018-May 2019 were evaluated. Of them 48 patients' file records and monitored capnography parameters such as heart rate, respiratory rate, blood pressure, capillary refill time, Glasgow Coma Score, SpO2, EtCO2, IPI recorded in the forms were reviewed.

Results Patients most often presented to the emergency room due to seizures (35.4%), change in consciousness (22.9%), other neurological reasons (18.8%) with %50 were female. Seizure treatment(16.7%), circulatory–respiratory support(16.7%), and antiedema treatments(6.3%) were required for 39.5% patients as life-saving interventions, and 72.9% patients were hospitalized. Patients with low IPI(<8) values at the beginning and decreasing IPI (<8) measurements within monitoring period needed more life-saving treatments(p=0.005 and p=0.001, respectively). Low IPI values of the patients during monitoring showed a significant difference in the decision to be hospitalized(p=0.048).

Conclusions The results of the present study indicate that monitoring with NICG in the pediatric emergency room can be an important early indicator in establishing clinical prediction. The study particularly points out that the IPI value can be a guide in decisions regarding life-saving treatment and hospitalization. Among the capnographic data of these patients who had a change in consciousness IPI values those measured at the beginning and within the monitorizarion period showed a significant correlation with low GCS (<8) (r=0.478, p=0.001 and r=0.456, p=0.02, respectively). Prospective comprehensive large scale studies are needed to examine the use of NICG and IPI in routine PED practice for various indications.

Zusammenfassung

Fragestellung und Hintergrund Für die nicht-invasive Kapnographie (NICG) konzipierte Geräte können die Sauerstoffsättigung, das endexspiratorische CO2 (EtCO2), die Atem- und Herzfrequenz sowie den integrierten Lungenindex (IPI) bestimmen. Ziel der vorliegenden Studie war es, Patienten, die aufgrund unterschiedlicher Indikationen in einer pädiatrischen Notaufnahme mittels NICG überwacht wurden, zu beurteilen und den Beitrag, den NICG bei der Behandlung von Patienten in der pädiatrischen Notaufnahme leisten kann, zu klären.

Patienten und Methodik Die Studie untersuchte Kinder im Alter von <18 Jahren, die in der pädiatrischen Notaufnahme unserer Universitätsklinik mittels nicht-invasiver Kapnographie zwischen August 2018 und Mai 2019 überwacht wurden. Von diesen Patienten wurden 48 Krankenakten und die auf Überwachungsbögen erhobenen Kapnographie-Parameter, wie Herz- und Atemfrequenz, Blutdruck, Rekapillarisierungszeit, Glasgow-Coma-Score, SpO2, EtCO2 und IPI, analysiert.

Ergebnisse Die Vorstellung in der Notaufnahme erfolgte am häufigsten aufgrund von Krampfanfällen (35,4 %), Bewusstseinsstörungen (22,9 %) und anderen neurologischen Auffälligkeiten (18,8 %); 50 % der Patienten waren weiblich. Als lebensrettende Maßnahmen waren bei 39,5 % der Patienten eine Anfallsbehandlung (16,7 %), Unterstützung von Atmung und Kreislauf (16,7 %) oder Ödembehandlung (6,3 %) erforderlich; 72,9 % der Patienten wurden stationär aufgenommen. Patienten mit initial niedrigen IPI-Scores (<8) und abfallenden IPI-Scores (<8) während der Überwachung benötigten häufiger lebensrettende Maßnahmen (p = 0,005 bzw. p = 0,001). Für niedrige IPI-Scores von Patienten während der Überwachung fand sich ein signifikanter Unterschied hinsichtlich der Entscheidung zur stationären Aufnahme (p = 0,048).

Schlussfolgerung Die Ergebnisse der vorliegenden Studie weisen darauf hin, dass die Überwachung von Patienten in der pädiatrischen Notaufnahme mittels NICG wichtige frühe Hinweise für die klinische Prognose liefern kann. Insbesondere stellt die Studie heraus, dass der IPI-Score als Orientierungshilfe bei Entscheidungen hinsichtlich lebensrettender therapeutischer Maßnahmen und einer stationären Aufnahme herangezogen werden kann. Die Kapnographie-Daten von Patienten mit Bewusstseinsstörungen zeigten eine signifikante Korrelation der IPI-Scores initial und während des Überwachungszeitraums mit niedrigen GCS-Scores (<8) (r = 0,478, p = 0,001 bzw. r = 0,456, p = 0,02). Es besteht Bedarf an großen, umfassenden, prospektiven Studien, in denen die routinemäßige Anwendung von NICG und IPI in der pädiatrischen Notaufnahme bei unterschiedlichen Indikationen untersucht wird.



Publication History

Article published online:
06 August 2021

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  • References

  • 1 Abramo T, Wiebe RA, Scott S. et al. Noninvasive capnometry monitoring for respiratory status during pediatric seizures. Crit Care Med 1997; 25: 1242-1246 doi:10.1097/00003246-199707000-00029
  • 2 Agus MS, Alexander JL, Mantell PA. Continuous non-invasive end-tidal CO2 monitoring in pediatric inpatients with diabetic ketoacidosis. Pediatr Diabetes. 2006; 7: 196-200 doi:10.1111/j.1399-5448.2006.00186.x
  • 3 ASA Standards for Basic Anesthetic Monitoring Approved by the ASA House of Delegates on October 21, 1986, last amended on October 20, 2010, and last affirmed on October 28, 2015 with an effective date of March 8, 2015 Available at: https://www.asahq.org/~/media/sites/asahq/files/public/resources/standards-guidelines/ standards-for-basic-anesthetic-monitoring.pdf. Accessed June 2020
  • 4 Coates BM, Chaize R, Goodman DM. et al. Performance of capnometry in non-intubated infants in the pediatric intensive care unit. BMC Pediatr 2014; 14: 163 doi:10.1186/1471-2431-14-163
  • 5 Evered L, Ducharme F, Davis M. et al. Can we assess asthma severity using expiratory capnography in a pediatric emergency department?. CJEM. 2003; 5: 169-170 doi:10.1017/S1481803500006564
  • 6 Garah J, Adiv OE, Rosen I. et al. The value of Integrated Pulmonary Index (IPI) monitoring during endoscopies in children. J Clin Monit Comput 2015; 29: 773-778 doi:10.1007/s10877-015-9665-z
  • 7 Gilhotra Y, Porter P. Predicting diabetic ketoacidosis in children by measuring end-tidal CO2 via non-invasive nasal capnography. Journal of Paediatrics and Child Health. 2007; 43: 677-680 doi:10.1111/j.1440-1754.2007.01186.x
  • 8 Howe TA, Jaalam K, Ahmad R. et al. The use of end-tidal capnography to monitör non-intubated patients presenting with acute exacerbation of astma in the emergency department. The Journal of Emergency Medicine. 2011; 41: 581-589 doi:10.1016/j.jemermed.2008.10.017
  • 9 Joint Commission Sentinel Event Alert: Issue 49, August 8, 2012. The Joint Commission Web site. Available at: http://www.jointcommission.org. Accessed June 2015
  • 10 Koniaris LG, Wilson S, Drugas G. et al. Capnographic monitoring of ventilatory status during moderate (conscious) sedation. Surg Endosc. 2003; 17: 1261-1265 doi:10.1007/s00464-002-8789-7
  • 11 Krauss B, Hess DR. Capnography for procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2007; 50: 172-181 doi:10.1016/j.annemergmed.2006.10.016
  • 12 Langhan ML, Shabanova V, Li FY. et al. A randomized controlled trial of capnography during sedation in a pediatric emergency setting. Am J Emerg Med. 2015; 33: 25-30 doi:10.1016/j.ajem.2014.09.050
  • 13 Langhan ML, Kurtz JC, Schaeffer P. et al. Experiences with capnography in acute care settings: A mixed-methods analysis of clinical staff. Journal of Critical Care. 2014; 29: 1035-1040 doi:10.1016/j.jcrc.2014.06.021
  • 14 Lightdale JR, Fredette ME, Atmadja ML. et al. M1563: Pilot Study of the Smart Capnography Integrated Pulmonary Index™ in a Pediatric Gastroenterology Procedure Unit. Gastrointestinal Endoscopy 2010; 71: AB255 doi:10.1016/j.gie.2010.03.564
  • 15 Long B, Koyfman A, Vivirito MA. Capnography in the emergency department: A review of uses, waveforms, and limitations. The J.Emerg. Med. 2017; 53: 829-842 doi:10.1016/j.jemermed.2017.08.026
  • 16 Maddox RR, Williams CK. Clinical Experience with Capnography Monitoring for PCA Patients. The Official Journal of the Anesthesia Patient Safety Foundation. 2012; 26: 47-50
  • 17 Manifold CA, Davids N, Villers LC. et al. Capnography for the nonintubated patient in the emergency setting. J Emerg Med. 2013; 45: 626-632 doi:10.1016/j.jemermed.2013.05.012
  • 18 Moses JM, Alexander JL, Agus MS. The correlation and level of agreement between end-tidal and blood gas pCO2 in children with respiratory distress: a retrospective analysis. BMC Pediatr. 2009; 9: 20. Published 2009 Mar 12. doi:10.1186/1471-2431-9-20
  • 19 Nik Hisamuddin NA, Rashidi A, Chew KS. et al. Correlations between capnographic waveforms and peak flow meter measurement in emergency department management of asthma. Int J Emerg Med. 2009; 2: 83-89 doi:10.1007/s12245-009-0088-9
  • 20 Nunn JF. Ventilation and end-tidal carbon dioxide tension. Anaesthesia. 1958; 13: 14 doi:10.1111/j.1365-2044.1958.tb08044.x
  • 21 Ronen M, Weissbrod R, Overdyk FJ. et al. Smart respiratory monitoring: Clinical development and validation of the IPI™ (Integrated Pulmonary Index) algorithm. J Clin Monit Comput. 2017; 31: 435-442 doi:10.1007/s10877-016-9851-7
  • 22 Rose Bovino L, Brainard C, Beaumier K. et al. Use of Capnography to Optimize Procedural Sedation in the Emergency Department Pediatric Population. J Emerg Nurs. 2018; 44: 110-116 doi:10.1016/j.jen.2017.10.016
  • 23 Waugh JB, Epps CA, Khodneva YA. Capnography enhances surveillance of respiratory events during procedural sedation: a meta-analysis. J Clin Anesth. 2011; 23: 189-196 doi:10.1016/j.jclinane.2010.08.012
  • 24 Yang HW, Jeon W, Min YG, Lee JS. Usefulness of end-tidal carbon dioxide as an indicator of dehydration in pediatric emergency departments: A retrospective observational study. Medicine (Baltimore). 2017; 96: e7881 doi:10.1097/md.0000000000007881
  • 25 Yıldızdaş RD, Yapıcıoğlu H, Yılmaz HL. The Value of Capnography During Sedation or Sedation/Analgesia in Pediatric Minor Procedures. Pediatric Emergency Care 2004; 20: 162-165 doi:10.1097/01.pec.0000117922.65522.26