A role of end-tidal CO2 monitoring for assessment of tracheal intubations in very low birth weight infants during neonatal resuscitation at birth

Aim: To investigate whether end-tidal CO2 monitoring is useful for more rapid recognition of tracheal vs. esophageal intubation as compared to standard clinical evaluation in very low birth weight infants during neonatal resuscitation at birth. Patients and methods: Forty infants were prospectively identified. Tracheal tube placement was evaluated either using an end-tidal CO2 monitor by an investigator not involved in the resuscitation, or by evaluation of clinical parameters by a resuscitation team unaware of the end-tidal CO2 data. The time taken to detect accurate placement of the tube using capnometory vs. clinical determination of tracheal or esophageal tube placement was compared. Results: A total of 54 intubations was analyzed from 40 neonates. End-tidal CO2 monitoring correctly identified all 40 tracheal and all 11 esophageal intubations with 100% accuracy. On the other hand, clinical evaluation demonstrated discrepancies in three cases. The mean time in seconds for capnographic determination was significantly faster than clinical determination for both tracheal (7.5 +/- 1.3 vs. 17.0 +/- 3.4, P < 0.01) and esophageal intubation (6.5 +/- 0.7 vs. 19.9 +/- 1.8, P < 0.01). Conclusion: Exhaled CO2 detection is a sensitive and accurate technique to confirm tracheal tube placement in very low birth weight infants during neonatal resuscitation.