Endotracheal Tube with End-tidal Carbon Dioxide Port
Bibliographic record
Abstract
We are delighted that our report has stimulated some interesting discussion on the challenges of end-tidal carbon dioxide monitoring.1Dr. Her describes his experience with a new type of endotracheal tube, which has a built-in end-tidal carbon dioxide monitoring port (Mallinckrodt Inc., St. Louis, MO). We agree that the complication seen in our patient could have been avoided with this form of tube because dislodgement and distal migration are less likely. There are some other advantages that should be noted. Because the monitoring line does not occupy the inner lumen, airway resistance is not increased. This is particularly relevant for very low-birth-weight infants, where 2.0- to 2.5-mm uncuffed endotracheal tubes are commonly used and airway resistance is most likely to be affected. This type of tube can be easily used with an appropriate end-tidal measuring system, provided the sample volume aspirated does not compromise the delivered tidal volume.There are some limitations that need to be pointed out. The additional tubing may become entangled with other tubes (e.g. , nasogastric tube) or may be pulled on by an active patient, both potentiating an accidental extubation. If the tube is inadvertently cut (e.g. , during tube suturing or taping) or the stopcock is left open to the atmosphere, a leak may occur, leading to ventilator autocycling and suboptimal tidal volume delivery. If used chronically for long-standing ventilated patients, the sampling line may become occluded by mucous or water secondary to circuit humidification. Finally, the current cost of the device may prohibit widespread use.Although continuous end-tidal carbon dioxide is a close measure of arterial carbon dioxide partial pressure in patients with normal ventilation and perfusion, it does not guarantee appropriate tube position.2It is most useful for trending or screening patients for abnormal carbon dioxide values. This type of endotracheal tube may be useful for patients requiring short-term procedural intubation in the operating room or during high-risk neonatal transport, where the risk of endotracheal tube migration/dislodgement is high. The reliability of this device needs careful prospective evaluation.*Hospital for Sick Children, Toronto, Ontario, Canada. patrick.mcnamara@sickkids.ca
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.007 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".