Comparison of end tidal carbon-di-oxide and clinical signs in assessing endotracheal intubation in children

Objectives: To compare the efficacy of end tidal carbon-di-oxide with clinical assessment in endotracheal tube placement in children and to correlate EtCo2 with various clinical conditions. Methods: Patients between 1 month to 18 years of age admitted to the emergency room requiring tracheal intubation were studied excluding patients admitted with cardiac arrest. Design and Setting: Prospective analytical study done in emergency room of a tertiary care pediatric hospital between September 2010 and June 2012. Results: Capnography identified all esophageal and airway intubations accurately except for 1 airway intubation. Clinical assessment identified all airway intubations correctly but only 1 out of 5 esophageal intubations. The mean time taken for confirmation of ET tube position by capnography was 8.15 ± 4.07secs and by clinical assessment was 22.45 ±14.44 secs and esophageal intubation by capnography was confirmed in 12.4 ± 4.77 sec and by clinical assessment in 35.8 ± 12.79 secs. EtCo2 identified underlying circulatory/ metabolic derangement thereby helping appropriate management. Conclusions: Capnography and clinical assessment were sensitive in identifying airway intubations, however only capnography was 100 % specific in identifying esophageal intubations. The mean time to assess tracheal and esophageal intubation was significantly less with capnography. Capnography did not discriminate between tracheal and bronchial intubation. Capnography helped monitoring response to treatment in children with shock, respiratory failure.