THE USE OF CAPNOGRAPHY FOR RECOGNITION OF ESOPHAGEAL INTUBATION IN THE NEONATAL INTENSIVE-CARE UNIT

Failure to recognize esophageal intubation can result in severe hypoxi a and permanent neurologic injury. Capnography is a standard monitorin g modality in the operating room but has not been utilized fully in ot her environments. We used capnography at the time of endotracheal intu bation in the neonatal intensive care unit (NICU) to determine whether capnography could more quickly and accurately identify endotracheal t ube position than other clinical indicators of endotracheal tube posit ion. One hundred intubation episodes were studied in 55 neonates. Capn ograms were obtained 15 and 120 sec following tube placement. Intubati ng personnel were blinded to the capnographic data and determined endo tracheal tube location (trachea vs. esophagus) by clinical criteria on ly. The sensitivity and specificity of capnography and clinical examin ation for identification of tube position were analyzed, and the time required for establishing by clinical confirmation whether the tube wa s in the trachea or not was compared to that required for capnography. Forty of 100 intubation attempts resulted in esophageal intubation. C apnography correctly identified these errant tube placements in 39 of 40 instances and did so in 1.6 sec (SD +/- 2.4). Capnography failed to identify successful endotracheal intubation on only one occasion. Cli nical indicators of tube position required 97.1 sec (SD +/- 92.6) to i dentify an esophageal intubation and failed to identify successful end otracheal intubation in 5 of 60 cases. We conclude that capnography is a valuable adjunct to clinical examination to demonstrate whether an endotracheal tube is placed correctly in the trachea of neonates in th e NICU. (C) 1995 Wiley-Liss, Inc.