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

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.

Key words

Pediatric emergency - Integrated Pulmonary Index - Noninvasive capnography - End-tidal carbon dioxide

Schlüsselwörter

integrierter Lungenindex - nichtinvasive Kapnographie - Pädiatrischer - Notfall - endexspiratorisches CO₂

Publication History

Article published online:
06 August 2021

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