ORIGINAL ARTICLE

Monitoring of end tidal carbon dioxide and transcutaneous carbon dioxide during neonatal transport

D G Tingay^1,2,4, M J Stewart^1,2,3 and C J Morley^1,3,4

¹ Neonatal Emergency Transport Service (Victoria), Royal Women’s Hospital, Carlton, Victoria 3053, Australia
² Department of Neonatology, Royal Children’s Hospital, Parkville, Victoria 3052, Australia
³ Department of Neonatology, Royal Women’s Hospital
⁴ Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia

Correspondence to:
Correspondence to:
Dr Tingay
Department of Neonatology, Royal Children’s Hospital, Flemington Rd, Parkville, Victoria 3052, Australia; david.tingay{at}rch.org.au

Objective: To assess the accuracy of measurements of end tidal carbon dioxide (CO₂) during neonatal transport compared with arterial and transcutaneous measurements.

Design: Paired end tidal and transcutaneous CO₂ recordings were taken frequently during road transport of 21 ventilated neonates. The first paired CO₂ values were compared with an arterial blood gas. The differences between arterial CO₂ (PaCO₂), transcutaneous CO₂ (TcPCO₂), and end tidal CO₂ (PetCO₂) were analysed. The Bland-Altman method was used to assess bias and repeatability.

Results: PetCO₂ correlated strongly with PaCO₂ and TcPCO₂. However, PetCO₂ underestimated PaCO₂ at a clinically unacceptable level (mean (SD) 1.1 (0.70) kPa) and did not trend reliably over time within individual subjects. The PetCO₂ bias was independent of PaCO₂ and severity of lung disease.

Conclusions: PetCO₂ had an unacceptable under-recording bias. TcPCO₂ should currently be considered the preferred method of non-invasive CO₂ monitoring for neonatal transport.

Abbreviations: PaCO₂, arterial partial pressure of carbon dioxide; TcPCO₂, transcutaneous partial pressure of carbon dioxide; PetCO₂, end tidal partial pressure of carbon dioxide; NETS, Newborn Emergency Transport Service (Victoria); PAO₂/PaO₂ ratio, alveolar-arterial oxygen tension ratio

Keywords: transportation; carbon dioxide; monitoring; mechanical ventilation

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