End‐Tidal Carbon Dioxide Monitoring in Neonates Receiving Therapeutic Hypothermia for Hypoxic‐Ischemic Encephalopathy
Bibliographic record
Abstract
ABSTRACT Introduction Primary aim was to assess the agreement between end‐tidal carbon dioxide (etCO 2 ) monitoring and arterial, capillary and venous PCO 2 values in mechanically ventilated patients receiving therapeutic hypothermia (TH) for hypoxic‐ischemic encephalopathy (HIE). Secondary, to assess the percentage of time spent in predefined PCO 2 ranges based on continuous etCO 2 monitoring. Methods In this prospective observational single center trial, infants with moderate‐to‐severe HIE receiving conventional ventilation with sidestream capnography were enrolled. Blood gas measurements were performed based on clinical indication. The mean of 12,000 etCO 2 values obtained over 10 min before each corresponding blood gas was used for analysis. The agreement between mean etCO 2 and temperature corrected and uncorrected PCO 2 at 37 ◦ C were analyzed using Bland‐Altman (BA) plots. Results A total of 262 paired PCO 2 and etCO 2 values were analyzed from 35 patients. The bias between temperature corrected arterial PCO 2 and etCO 2 ( n = 116) was 1.87 mmHg (SD 5.54) with −8.99 and 12.73 limits of agreement; whereas the bias between capillary PCO 2 and etCO 2 ( n = 132) was 7.22 mmHg (SD 6.08). EtCO 2 underestimated PCO 2 of any source at 37°C. Excluding patients with lung diseases from BA analysis did not show improvement in the agreement. Infants spent median 23.9% [IQR 8.5; 36.7] of monitoring time in etCO 2 range < 35 mmHg and median 75.0% [IQR 61.1; 87.7] in etCO 2 range of 35‐55 mmHg. Conclusions EtCO 2 monitoring may be a valuable addition to neurocritical care of infants with HIE as it showed a strong level of agreement with temperature corrected arterial PCO 2 .
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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 | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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".