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Alterations of end‐tidal carbon dioxide during the intrahospital transport of children

Objective To determine the effect of manual ventilation during intrahospital transport on end-tidal carbon dioxide concentrations in children. Design Prospective study in children who required tracheal intubation and mechanical ventilation/hyperventilation to maintain an arterial partial pressure of CO2 (PaCO2) of 25 to 30 torr for control of intracranial pressure. Setting Pediatric intensive care unit. Intervention During patient transport with manual ventilation, end-tidal CO2 was monitored with a side-streaming aspirating, infrared device. The person responsible for manual ventilation was informed of the current ventilator settings and the need to maintain a PaCO2 of 25 to 30 torr, but was not allowed to see the end-tidal CO2 monitor. Results The study population included 12 patients ranging in age from seven months to 14 years (average age 6.9 years) and in weight from 6.5 to 57 kg (average weight 28.9 kg). A total of 1716 end-tidal CO2 values were recorded during 286 minutes of monitoring. Five hundred and thirty-one (31%) of the readings were in the intended range of 25 to 30 torr. Four hundred (23%) were less than 20 torr, 665 (39%) were in the 20 to 24 torr range, and 119 (6.3%) were greater than 30 torr. Only five were greater than 40 torr. Conclusions Unintentional hyperventilation occurs during the intrahospital transport of children. End-tidal CO2 values less than 25 torr were noted 62% of the time.