Citation | Study group | Study type | Outcome | Key results | Comments |
---|---|---|---|---|---|
Hosono et al7 | 54 intubations in 40 neonates in the delivery room were analysed | Prospective cohort | ETT placement was compared using Pedi-Cap by an investigator not involved in the resuscitation, and by evaluation of clinical parameters by a resuscitation team unaware of the ETCO2 data | Capnography: sensitivity and specificity 100% | Resuscitation team blinded to ETCO2 result. Investigator not involved in resuscitation |
Clinical: sensitivity 92.5% and specificity 82.4% | |||||
Mean birth weight 839±263 g | Mean time for capnographic determination was significantly less than for clinical determination for both tracheal 7.5 (±1.3) s vs 17.0 (±3.4) s (p<0.01) and oesophageal intubation 6.5 (±0.7) s vs 19.9 (±1.8) s (p<0.01) | ||||
Mean gestational age 27.0±2.5 weeks | |||||
The clinical parameter was used as the gold standard | |||||
The times taken to detect accurate placement of the ETT using ETCO2 vs clinical determination of tracheal or oesophageal tube placement were compared | |||||
Repetto et al10 | 27 intubations in 16 patients were analysed | Prospective cohort | The times taken using ETCO2 and clinical determinations of ETT placement in the delivery room were compared | The median (range) times required for capnographic and clinical determination of tracheal intubation were 9 (4–26) s vs 35 (18–70) s (p<0.001), and for oesophageal intubation were 9 (4–17) s vs 30 (25–111) s (p=0.001) | High rate of oesophageal intubation (11/27=40%) |
Birth weight 575–2040 g | Only delivery room intubations | ||||
Hand-held, portable CO2 monitor providing CO2 readout was used instead of Pedi-Cap | |||||
Gestational age 23–34 weeks | |||||
Investigator not involved in resuscitation, or resuscitation team unaware of the ETCO2 data | |||||
Aziz et al4 | 45 newborns (450–4620 g) who needed endotracheal intubation | Prospective cohort | Accuracy and ease of the Pedi-Cap | Correlated in 30 of 33 patients (sensitivity 91%, specificity 100%) | Resuscitation team blinded to the colour status of the Pedi-Cap |
Pedi-Cap correlation with clinical evaluation and radiography findings for endotracheal intubation | |||||
Correlated in 12 of 12 patients (sensitivity, specificity, and PPV and NPV were all 100%) | |||||
Three false negatives with severe cardiorespiratory depression | |||||
34 (53.3%) were intubated in the delivery room and 21 (46.7%) in the NICU | |||||
Clinical evaluation: 0–90 s (mean 39.7±15.3 s) | Negative result in CPR is not assessable as four infants needing most resuscitation were excluded | ||||
Pedi-Cap correlation with clinical evaluation for ETT in the oesophagus | ETCO2 detector: 4–12 s (mean 8.1±2.9 s) (p<0.001) | ||||
No measure of success of resuscitation | |||||
Comparison of time required to determine tube position by clinical evaluation and ETCO2 | |||||
Roberts et al11 | 100 intubations in 55 neonates in the NICU were studied | Prospective cohort | Capnography and clinical examination for identification of tube position were analysed | 40/100 intubation attempts resulted in oesophageal intubation | Useful observational study and the intubating clinicians were blinded to the capnography |
Capnography correctly identified oesophageal tube placement in 39/40 and did so in a mean of 1.6±2.4 s. Capnography failed to identify successful endotracheal intubation on only one occasion | |||||
Study was carried out in a neonatal unit and not in the delivery room | |||||
Mean birth weight 1419±811 g | The time required for establishing by clinical confirmation whether the tube was in the trachea or not was compared to that required for capnography | ||||
A hand-held, portable CO2 monitor was used instead of Pedi-Cap | |||||
Mean gestational age 28.5±4.0 weeks | |||||
Clinical indicators of tube position required 97.1+/–92.6 s to identify oesophageal intubation and failed to identify successful endotracheal intubation in 5 of 60 cases |
ETCO2, end tidal CO2; ETT, endotracheal tube; NICU, neonatal intensive care unit; NPV, negative predictive value; PPV, positive predictive value.