Impact of Continuous Capnography in Ventilated Neonates: A Randomized, Multicenter Study

Objective To compare the time spent within a predefined safe range of CO₂ (30-60 mmHg) during conventional ventilation between infants who were monitored with distal end-tidal CO₂ (dETCO₂, or capnography) and those who were not. Study design For this randomized, controlled multicenter study, ventilated infants with a double-lumen endotracheal tube were randomized to 1 of 2 groups: the open (monitored) group, in which data from the capnograph were recorded, displayed to the medical team, and used for patient care, and the masked group, in which data from the capnograph were recorded. However, the measurements were masked and not available for patient care. dETCO₂ was compared with PaCO₂ measurements recorded for patient care. Results Fifty-five infants (25 open, 30 masked) participated in the study (median gestational age, 28.6 weeks; range, 23.5-39.0 weeks). The 2 groups were comparable. dETCO₂ was in good correlation (r = 0.73; P <.001) and adequate agreement (mean ± SD of the difference, 3.0 ± 8.5 mmHg) with PaCO₂. Compared with infants in the masked group, those in the monitored group had significantly (P =.03) less time with an unsafe dETCO₂ level (high: 3.8% vs 8.8% or low: 3.8% vs 8.9%). The prevalence of intraventricular hemorrhage or periventricular leukomalacia rate was lower in the monitored group (P =.02) and was significantly (P <.05) associated with the independent factors dETCO₂ monitoring and gestational age. Conclusion Continuous dETCO₂ monitoring improved control of CO₂ levels within a safe range during conventional ventilation in a neonatal intensive care unit. Trial registration ClinicalTrials.gov: NCT01572272.