Abstract

BACKGROUND: Carbon dioxide concentration trending is used in chronic management of children with invasive home mechanical ventilation (HMV) in clinical settings, but options for end-tidal carbon dioxide (EtCO(2) ) monitoring at home are limited. We hypothesized that a palm-sized, portable endotracheal capnograph (PEC) that measures EtCO(2) could be adapted for in-home use in children with HMV. METHODS: We evaluated the internal consistency of the PEC by calculating an intraclass correlation coefficient of three back-to-back breaths by children (0-17 years) at baseline health in the clinic. Pearson's correlation was calculated for PEC EtCO(2) values with concurrent mean values of in-clinic EtCO(2) and transcutaneous CO(2) (TCM) capnometers. The Bland-Altman test determined their level of agreement. Qualitative interviews and surveys assessed usability and acceptability by family-caregivers at home. RESULTS: CO(2) values were collected in awake children in varied activity levels and positions (N = 30). The intraclass correlation coefficient for the PEC was 0.95 (p < 0.05). the correlation between the pec and in-clinic etco(2) device was 0.85 with a mean difference of -3.8 mmhg and precision of ±1.1 mmhg. the correlation between the pec and the clinic tcm device was 0.92 with a mean difference of 0.2 mmhg and precision of ±1.0. family-caregivers (n =" 10)" trialed the pec at home; all were able to obtain measurements at home while children were awake and sometimes asleep. conclusions: a portable, noninvasive device for measuring etco(2) was feasible and acceptable, with values that trend similarly to currently in-practice, outpatient models. these devices may facilitate monitoring of etco(2) at home in children with invasive hmv.>

DOI 10.1002/PPUL.26092