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Background  To investigate the correlation and level of agreement between end-tidal carbon dioxide (EtCO 2 ) and blood gas pCO 2  in non-intubated children with moderate to severe respiratory distress.    Methods  Retrospective study of patients admitted to an intermediate care unit (InCU) at a tertiary care center over a 20-month period with moderate to severe respiratory distress secondary to asthma, bronchiolitis, or pneumonia. Patients with venous pCO 2  (vpCO 2 ) and EtCO 2  measurements within 10 minutes of each other were eligible for inclusion. Patients with cardiac disease, chronic pulmonary disease, poor tissue perfusion, or metabolic abnormalities were excluded.    Results  Eighty EtCO 2 -vpCO 2  paired values were available from 62 patients. The mean ±  SD  for EtCO 2  and vpCO 2  was 35.7 ± 10.1 mmHg and 39.4 ± 10.9 mmHg respectively. EtCO 2  and vpCO 2  values were highly correlated (r = 0.90, p < 0.0001). The correlations for asthma, bronchiolitis and pneumonia were 0.74 (p < 0.0001), 0.83 (p = 0.0002) and 0.98 (p < 0.0001) respectively. The mean bias ±  SD  between EtCO 2  and vpCO 2  was -3.68 ± 4.70 mmHg. The 95% level of agreement ranged from -12.88 to +5.53 mmHg. EtCO 2  was found to be more accurate when vpCO 2  was 35 mmHg or lower.    Conclusion  EtCO 2  is correlated highly with vpCO 2  in non-intubated pediatric patients with moderate to severe respiratory distress across respiratory illnesses. Although the level of agreement between the two methods precludes the overall replacement of blood gas evaluation, EtCO 2  monitoring remains a useful, continuous, non-invasive measure in the management of non-intubated children with moderate to severe respiratory distress.

The correlation and level of agreement between end-tidal and blood gas pCO2in children with respiratory distress: a retrospective analysis