Continuous Noninvasive Carbon Dioxide Monitoring in Neonates: From Theory to Standard of Care

Abstract

Ventilatory support may affect the short- and long-term neurologic and respiratory morbidities of preterm infants. Ongoing monitoring of oxygenation and ventilation and control of adequate levels of oxygen, pressures, and volumes can decrease the incidence of such adverse outcomes. Use of pulse oximetry became a standard of care for titrating oxygen delivery, but continuous noninvasive monitoring of carbon dioxide (CO2) is not routinely used in NICUs. Continuous monitoring of CO2 level may be crucial because hypocarbia and hypercarbia in extremely preterm infants are associated with lung and brain morbidities, specifically bronchopulmonary dysplasia, intraventricular hemorrhage, and cystic periventricular leukomalacia. It is shown that continuous monitoring of CO2 levels helps in maintaining stable CO2 values within an accepted target range. Continuous monitoring of CO2 levels can be used in the delivery room, during transport, and in infants receiving invasive or noninvasive respiratory support in the NICU. It is logical to hypothesize that this will result in better outcome for extremely preterm infants. In this article, we review the different noninvasive CO2 monitoring alternatives and devices, their advantages and disadvantages, and the available clinical data supporting or negating their use as a standard of care in NICUs.

Correlation of End-Tidal Carbon Dioxide with Arterial Carbon Dioxide in Mechanically Ventilated Neonates: A Scoping Review

“…It is a method that can be used in invasive and non-invasive ventilation and even in unventilated patients, while the expired CO 2 is used in IMV. 8 One criteria of the review were to include the newborns submitted to IMV, which can have affected the smaller number of studies with a transcutaneous approach.…”

“…Transcutaneous measurement of CO 2 (tcCO 2 ) is based on the diffusion of CO 2 through body tissues, which can be detected by a sensor positioned on the skin surface. 8 Capnometry quantifies the level of CO 2 throughout the respiratory cycle by means of its concentration in exhaled air at the end of exhalation (PetCO 2 ). It is used for successful verification of orotracheal intubation, assessment of pulmonary circulation and respiratory status, and optimization of mechanical ventilation.…”

Transcutaneous PCO2‐based dead space ventilation at submaximal exercise accurately discriminates healthy controls from patients with chronic obstructive pulmonary disease

“…PtcCO 2 monitoring is now standard of care in neonatology (Hochwald et al. 2019). PtcCO 2 can be used as a surrogate for PaCO 2 to calculate dead space ventilation in sedated patients receiving mechanical ventilation (Lakshminarayana et al.…”

Neurocritical care of premature infants

“…revealed that CO2 fluctuations are associated with changes in cerebral oxygenation and electrical activity in the first 72 h of life in preterm infants [ 46 ]. Therefore, to avoid significant hypocarbia and hypercarbia, and to prevent related brain injury, it might be prudent to incorporate continuous non-invasive CO2 monitor into standard of care in the ventilated ELBW infants [ 47 ].…”