NONINVASIVE CAPNOMETRY MONITORING FOR RESPIRATORY STATUS DURING PEDIATRIC SEIZURES

Objective: To determine the reliability and clinical value of end-tida l CO2 by oral/nasal capnometry for monitoring pediatric patients prese nting post ictal or with active seizures. Design: Clinical, prospectiv e, observational study. Setting: University affiliated children's hosp ital. Interventions: One hundred sixty-six patients (105 patients with active seizures, 61 post ictal patients) had end-tidal CO2 obtained b y oral/nasal sidestream capnometry, and respiratory rates, oxygen satu ration, and pulse rates recorded every 5 mins until 60 mins had elapse d. End-tidal CO2 values were compared with a capillary Pco(2) and clin ical observation. Measurements and Main Results: The mean end-tidal CO 2 reading was 43.0 +/- 11.8 torr [5.7 +/- 1.6 kPa] and the mean capill ary Pco(2) reading was 43.4 +/- 11.7 torr [5.7 +/- 1.6 kPa]. The corre lation between end-tidal CO2 and capillary Pco(2) was significant (r(2 ) = .97; p < .0001). A relative average bias of 0.33 torr (0.04 kPa) w ith end-tidal CO2 lower than capillary Pco(2) was established with 95% limits of agreement +/-4.2 torr (+/-0.6 kPa). Variability of differen ce scores was not related to range of mean scores (r(2) = .00003), age (r(2) = .0004), or respiratory rates (r(2) = .0009). End-tidal CO2 (r (2) = .22; p < .001) correlated better with respiratory rate changes w hen compared with oxygen saturation (r(2) = .02; p = .01). Conclusions : Dependable end-tidal CO2 values can be obtained in pediatric seizure patients using an oral/nasal cannula capnometry circuit. Continuous e nd-tidal CO2 monitoring provides the clinician with a reliable assessm ent of pulmonary status that can assist with decisions to provide vent ilatory support.