Neonatal Transcutaneous Carbon Dioxide Monitoring—Effect on Clinical Management and Outcomes

Abstract

BACKGROUND: This work aimed to compare frequency of blood gas measurements per day of mechanical ventilation, occurrence of extreme blood gas CO 2 values, and clinical outcomes among ventilated neonates managed with and without transcutaneous carbon dioxide (P tcCO 2 ) monitors. This work also measures agreement between simultaneous P tcCO 2 and blood gas CO 2 measurements and ascertains factors that affect agreement. METHODS: This is a cohort study with retrospective analysis comparing 5,726 blood gas measurements and clinical outcomes for 123 neonates intubated for >48 h before and after the introduction of transcutaneous carbon-di-oxide monitoring devices in a single tertiary care unit. RESULTS: Median (interquartile range) blood gas frequency per mechanical ventilation day was 3.9 (2.6 -5.3) and 2.9 (2.1-4.0) before and after P tcCO 2 monitoring (P ‫؍‬ .002) without differences in clinical outcomes at discharge. After adjusting for confounders using Poisson regression, this difference remained significant. The mean ؎ 2 SD blood gas-P tcCO 2 difference was ؊5.2 ؎ 17.3 mm Hg. 64% of simultaneous blood gas-P tcCO 2 measurements per subject were within ؎7 mm Hg. Greater bias was noted with arterial sample and during the use of high-frequency ventilation. CONCLUSION: Despite only moderate agreement between simultaneous P tcCO 2 and blood gas measurements, P tcCO 2 monitoring statistically decreased blood gas frequency among ventilated neonates without affecting the duration of mechanical ventilation or clinical outcomes at discharge. The clinical impact of this technology appears to be minimal.

Electrical Activity of the Diaphragm in a Small Cohort of Preterm Infants on Noninvasive Neurally Adjusted Ventilatory Assist and Continuous Positive Airway Pressure: A Prospective Comparative Pilot Study

“…Beck et al [28] in a systematic review on the use of NAVA in children reported the mean Edi values ranging between 8 and 20 mcV. In the present study, the values of Edi peak on NIV NAVA and CPAP are similar to as reported by different authors [21,24], and falls within the range described by Beck et al It shows reproducibility and may indicate optimal respiratory muscle unloading on NIV NAVA.…”

“…Edi waveform is an estimate of the patient's own neuronal drive and is independent of any leaks giving information about lung stretch, respiratory muscle loading, and other inputs [17]. The utility of Edi monitoring while on respiratory support can be compared to the utility of end-tidal CO2 or transcutaneous CO2 monitoring in the intensive unit [24]. Since the majority of premature infants needing NIV require feeding catheters for either feeding or gastric decompression, Edi catheter tracings can be considered as an additional bedside clinical tool to monitor the effectiveness of the noninvasive support.…”

Accuracy and precision of transcutaneous carbon dioxide monitoring: a systematic review and meta-analysis

“…Transcutaneous CO 2 monitoring is commonly used to reduce the frequency of arterial blood gas analysis in neonates due to the limitations of other methods to estimate PaCO 2 in this population, such as end-tidal CO 2 and capillary blood gas analysis 22. Yet we identified weak evidence for accuracy and precision with population limits of agreement that were far outside the clinically acceptable range.…”

Transcutaneous blood gas monitoring among neonatal intensive care units in Japan

“…The Cochrane Neonatal Review Groups concluded that there was no evidence to recommend or refute the use of tcPCO 2 monitoring to prevent neonatal morbidity and mortality . However, the use of tcPCO 2 monitoring decreased the frequency of blood gas samplings among ventilated neonates without affecting the duration of mechanical ventilation or clinical outcome . The Neonatal Research Network in Japan, has reported the progress in survival and neurodevelopmental outcome of the infants born at the “limit of viability” .…”

“…18 However, the use of tcPCO 2 monitoring decreased the frequency of blood gas samplings among ventilated neonates without affecting the duration of mechanical ventilation or clinical outcome. 19 The Neonatal Research Network in Japan, has reported the progress in survival and neurodevelopmental outcome of the infants born at the "limit of viability". 1,2 Transcutaneous blood gas monitoring was expected to be useful (30.4%) in future neonatal medical care in Japan.…”