Can Non-Invasive Capnography and Integrated Pulmonary Index Contribute to Patient Monitoring in the Pediatric Emergency Department?

OBJECTIVES: Noninvasive capnography (NICG) devices can measure oxygen saturation, end-tidal carbon dioxide (EtCO2), respiratory rate, heart rate values and integrated pulmonary index (IPI). This study aimed to evaluate patients who were monitored using NICG for various indications in a pediatric emergency department and to determine its contribution to patient management in the pediatric emergency department (PED). METHODS: In this study, children aged <18 years who had been monitored with a NICG at the PED in our university between August 2018-May 2019 were evaluated. Of them 48 patients' file records and monitored capnography parameters such as heart rate, respiratory rate, blood pressure, capillary refill time, Glasgow Coma Score, SpO2, EtCO2, IPI recorded in the forms were reviewed. RESULTS: Patients most often presented to the emergency room due to seizures (35.4%), change in consciousness (22.9%), other neurological reasons (18.8%) with %50 were female. Seizure treatment(16.7%), circulatory-respiratory support(16.7%), and antiedema treatments(6.3%) were required for 39.5% patients as life-saving interventions, and 72.9% patients were hospitalized. Patients with low IPI(<8) values at the beginning and decreasing IPI (<8) measurements within monitoring period needed more life-saving treatments(p=0.005 and p=0.001, respectively). Low IPI values of the patients during monitoring showed a significant difference in the decision to be hospitalized(p=0.048). CONCLUSIONS: The results of the present study indicate that monitoring with NICG in the pediatric emergency room can be an important early indicator in establishing clinical prediction. The study particularly points out that the IPI value can be a guide in decisions regarding life-saving treatment and hospitalization. Among the capnographic data of these patients who had a change in consciousness IPI values those measured at the beginning and within the monitorizarion period showed a significant correlation with low GCS (<8) (r=0.478, p=0.001 and r=0.456, p=0.02, respectively). Prospective comprehensive large scale studies are needed to examine the use of NICG and IPI in routine PED practice for various indications.

The skills of defibrillation practice and certified life-support training in the healthcare providers in Turkey.

AIM OF THE STUDY: Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. The scope of this multi-centre study is to (a) assess skills of paediatric healthcare providers (HCPs) concerning two domains: (1) recognising rhythm abnormalities and (2) the use of defibrillator devices, and (b) to evaluate the impact of certified basic-life-support (BLS) and advanced-life-support (ALS) training to offer solutions for quality of improvement in several paediatric emergency cares and intensive care settings of Turkey. METHODS: This cross-sectional and multi-centre survey study included several paediatric emergency care and intensive care settings from different regions of Turkey. RESULTS: A total of 716 HCPs participated in the study (physicians: 69.4%, healthcare staff: 30.6%). The median age was 29 (27-33) years. Certified BLS-ALS training was received in 61% (n = 303/497) of the physicians and 45.2% (n = 99/219) of the non-physician healthcare staff (P < .001). The length of professional experience had favourable outcome towards an increased self-confidence in the physicians (P < .01, P < .001). Both physicians and non-physician healthcare staff improved their theoretical knowledge in the practice of synchronised cardioversion defibrillation (P < .001, P < .001). Non-certified healthcare providers were less likely to manage the initial doses of synchronised cardioversion and defibrillation: the correct responses remained at 32.5% and 9.2% for synchronised cardioversion and 44.8% and 16.7% for defibrillation in the physicians and healthcare staff, respectively. The indications for defibrillation were correctly answered in the physicians who had acquired a certificate of BLS-ALS training (P = .047, P = .003). CONCLUSIONS: The professional experience is significant in the correct use of a defibrillator and related procedures. Given the importance of early defibrillation in survival, the importance and proper use of defibrillators should be emphasised in Certified BLS-ALS programmes. Certified BLS-ALS programmes increase the level of knowledge and self-confidence towards synchronised cardioversion-defibrillation procedures.