Simple technique for Capnography monitoring in COVID-19 paediatrics patient.

Capnography or end‐tidal carbon dioxide (ETCO2) is a useful adjunct in assessing ventilation and can serve as an objective tool for assessing sedation/analgesia in pediatric intensive care and procedural sedation. The ability to continuously measure exhaled carbon dioxide can provide vital information about airway, breathing, and circulation in critically ill pediatric patients. It is recommended that carbon dioxide (CO2) monitoring should be immediately available for children undergoing sedation. [1] Sedation should be used with caution in any COVID‐19 pediatric patients as they may have co‐existing respiratory compromise from COVID‐19 pneumonia and close monitoring of oxygenation and ventilation is warranted. Whereas in the past it may have been acceptable to connect a CO2 sampling line directly to a patient's facemask, in the effort of avoiding contamination with COVID positive patients, the following assembly was created. We made a very simple and light weight assembly of Capnography monitoring by inserting a 7 cm cut part of 3.0 mm ID uncuffed ETT (Endotracheal tube) to one of the exhalation port of the pediatrics face mask. The distal end of the uncuffed 3.0 mm ID ETT very snugly fits into one of the hole of the exhalation port. We can keep the distal end of the ETT up to the radiopaque marker inside the face mask to avoid any resistance. A 15 mm ET Tube connector is attached to other end of the ETT which was then connected to a high‐efficiency particulate air (HEPA) heat and moisture exchanging (HME) filter. The CO2 sampling line is then connected to the HEPA HME so that sampled gas is filtered. (Figure 1). The CO2 tracing can be obtained to monitor respiratory rate but this can be also monitored by clinical observation and assessment by electrocardiogram systems that use impedance plethysmography. We are successfully using this assembly in suspected cases of COVID‐19 pediatric patients after completion of elective or emergency operative surgeries or cases of procedural sedation requiring CO2 sampling. However, it is not a tested method and there is no safety data available with any study at present. This assembly can be made easily from readily available materials and has the advantage of appropriate CO2 monitoring without risking contamination of equipment and potential harm to future patients.

FIGURE 1

Simple and light weight assembly of Capnography monitoring

CONFLICT OF INTEREST

Authors declare no conflict of interest.