In NICUs, PICUs, and sleep labs around the world, transcutaneous monitoring has increasingly become a trusted tool for continuous, noninvasive CO2 measurement. The technology can help reduce the need for frequent blood draws, enable proactive ventilator management, and offer additional benefits as care teams support diverse patient populations.

And now, Sentec is introducing something new to support the growing number of teams who are adopting this technology: the tCOM+ — the latest in transcutaneous CO2 monitoring, built on years of feedback and trust from our clinical partners around the globe.

Is now the right moment for your team to reconsider transcutaneous CO2 monitoring? Explore how it can help your team meet its care goals and discover why Sentec’s tCOM+ is the right choice for implementing the technology into your unit.

With the tCOM+ now available, it’s an ideal time to revisit the benefits of transcutaneous CO2 monitoring and how it can support both your patients and your team. Here are some of the key clinical benefits the technology offers:

When managing a patient on respiratory support, continuous visibility into their respiratory status is key for delivering informed, timely care. In critically ill patients, respiratory conditions can fluctuate unpredictably and deteriorate quickly. Continuous, real-time monitoring of ventilation and gas exchange can provide care teams with the critical insights needed to detect changes as they happen, enabling timely interventions to maintain optimal gas exchange.

Transcutaneous CO2 monitoring can also support the optimization of lung-protective strategies. With continuous visibility into CO2 levels, care teams can make precise adjustments to ventilator settings to find the window of support that’s as gentle as possible, but still meets the patient’s ventilatory needs. This approach is crucial in the NICU, where fragile neonatal lungs are highly susceptible to ventilator-induced injuries but is also important in critically ill pediatric and adult patients with compromised lungs.

Helps Minimize Blood Draws

For care teams looking to minimize blood draws in their unit, transcutaneous CO2 monitoring can be a valuable addition to their protocols. The technology offers a noninvasive alternative for measuring CO2, reducing the need for frequent laboratory testing without compromising visibility.

This approach can support broader care goals within a unit, including blood conservation strategies. Minimizing blood loss is particularly important for critically ill patients, especially in the NICU, where infants are highly susceptible to anemia. A reduction in blood draws can also minimize pain for patients — a key consideration for neonates who are sensitive to both short- and long-term effects of pain. This benefit extends beyond the NICU, contributing to a less invasive and more comfortable experience for patients throughout a facility.

In addition to supporting these care initiatives, transcutaneous monitoring can help reduce some of the other associated risks of drawing a patient’s blood, such as infection, as well as reduce the costs associated with frequent laboratory testing.

In the NICU: Addressing the Negative Effects of Pain

Research has unveiled a troubling connection: infants subjected to a high number of neonatal skin breaks, often linked to blood draws and other invasive procedures, display lower mental development indexes when evaluated at 8 and 18 months of age. ⁵  This detrimental influence continues to cast its shadow into the long term, affecting children even into their school years. ⁶ 

The implications of these findings underscore the need for strategies to mitigate pain and discomfort experienced in the NICU. By providing continuous CO2 readings, transcutaneous monitoring can reduce the need for frequent blood draws, allowing care teams to manage the patient’s condition with less reliance on invasive procedures.

Keep Reading: Pain and the Neonatal Brain Whitepaper

In the NICU: Reducing Blood Loss

A study found that neonates can lose up to 30% of their circulating blood volume to lab work during their first six weeks of life. ⁷  These procedures can be particularly concerning for premature patients, who don’t have much blood to give in the first place.

Noninvasive CO2 monitoring through transcutaneous technology can reduce reliance on blood draws while still providing continuous, accurate respiratory monitoring to guide care. This approach can play a vital role in your unit’s blood conservation strategy, helping your team minimize blood loss in these vulnerable patients.

Keep Reading: Blood Loss in the NICU Whitepaper

Maintains Visibility — No Matter Your Ventilation Strategy 

As use of noninvasive (NIV) and specialty ventilation modalities grows across care areas, transcutaneous monitoring can support your team in keeping accurate CO2 values in sight. This noninvasive CO2 monitoring method is not impacted by mask or cuff leaks, V/Q mismatch, or variations in respiration rate and tidal volume, and is compatible with any mode of ventilatory support, including:

In the PICU: Prioritizing NIV and Maintaining Visibility

As standards of care evolve, data show a significant rise in the use of NIV in the PICU, alongside a decrease in mechanical ventilation (MV). ¹⁰ While NIV helps reduce the risks associated with MV, it presents challenges in monitoring CO2 levels. End-tidal CO2 monitoring is often infeasible with NIV and specialty ventilation methods, leading to some loss of visibility into the patient’s respiratory status.

As critically ill patients are increasingly managed with NIV, transcutaneous CO2 monitoring can restore visibility into CO2 levels. It is compatible with both specialty and noninvasive ventilation modes, enabling clinicians to make informed decisions and optimize care for these vulnerable patients.

Keep Reading: Challenging Patients, Limited Visibility: Prioritizing NIV in the PICU Whitepaper

In the Sleep Lab: Overcoming the Limitations of Capnography

Elevated CO2 levels are commonly seen in patients undergoing sleep studies. Research shows that up to 46% of pediatric patients with sleep-disordered breathing experience a nocturnal increase in tcpCO2 greater than 10 mmHg, ⁸  while another study found that 17% of adults with obstructive sleep apnea (OSA) may also experience hypercapnia. ⁹ 

Although some sleep labs use capnography, or end-tidal CO2 monitoring, this method has notable limitations for sleep lab patients, particularly those using BiPAP or other noninvasive ventilation (NIV) methods. For these patients, the flow from support can mix with the patient’s exhaled breath, potentially leading to an underestimation of PaCO2 levels. Transcutaneous CO2 (tcPCO2) monitoring proves beneficial in these cases, as it monitors through the skin instead of through a cannula, with measurements remaining reliable even with the addition of respiratory support.

Keep Reading: Case Studies from the Nemours Children’s Hospital Pediatric Sleep Lab

References:

1. Hochwald, O., et al. Continuous Noninvasive Carbon Dioxide Monitoring in Neonates: From Theory to Standard of Care. Pediatrics. 2019.
2. Madotto, F., et al. Patterns and Impact of Arterial CO2 Management in Patients With Acute Respiratory Distress Syndrome. CHEST. 2020.
3. Fuller, B.M., et al. Partial pressure of arterial carbon dioxide and survival to hospital discharge among patients requiring acute mechanical ventilation: A cohort study. J Crit Care. 2017.
4. Nin, N., et al. Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome. Intensive Care Med. 2017.
5. Grunau, R.E., et al. Neonatal Pain, Parenting Stress and Interaction, In Relation To Cognitive And Motor Development At 8 And 18 Months In Preterm Infants. Pain. 2009.
6. Doesburg, S.M., et al. Neonatal Pain-Related Stress, Functional Cortical Activity and Visual-Perceptual Abilities In School-Age Children Born At Extremely Low Gestational Stage. Pain. 2013.
7. Carroll, P.D., Widness, J.A. Nonpharmacological, blood conservation techniques for preventing neonatal anemia–effective and promising strategies for reducing transfusion. Semin Perinatol. 2012.
8. Pautrat, J., et al. Carbon Dioxide Levels During Polygraphy in Children with Sleep-Disordered Breathing. Sleep Breath. 2015.
9. Resta, O., et al. Hypercapnia in obstructive sleep apnoea syndrome. Neth J Med. 2000.
10. Essouri, S., et al. Improved clinical and economic outcomes in severe bronchiolitis with pre-emptive nCPAP ventilatory strategy. Intensive Care Med. 2014.