Introduction
In the NICU, critically ill and premature babies receive specialized, around-the-clock care to support their fragile health. This often means using respiratory support to help with their breathing, especially important for little ones with underdeveloped or compromised lungs. This level of care requires constant vigilance from NICU teams, as these patients can have rapid changes in their respiratory status, and are also at risk for lung damage from respiratory support. By using transcutaneous CO2 monitoring, NICU teams can keep a constant eye on their status, which helps them fine-tune and optimize the support they need.
Here, we’ll explore how transcutaneous CO2 monitoring can enhance care in the NICU, highlighting four key clinical use cases:
- Reducing iatrogenic blood loss
- Continuous monitoring, titration, and weaning of mechanical ventilation
- Continuous monitoring for high-frequency ventilation (HFV)
- Reducing neonatal pain and stimulation
Applications of Transcutaneous CO2 Monitoring in Neonatal Care
Familiarizing yourself with these clinical use cases can help you see where transcutaneous CO2 monitoring could fit into your NICU’s care strategies. It can also empower your team to integrate transcutaneous monitoring into unit protocols, or broaden its application in your facility, ensuring you fully leverage its benefits for your patients.
Applications of Transcutaneous CO2 Monitoring in Neonatal Care
Familiarizing yourself with these clinical use cases can help you see where transcutaneous CO2 monitoring could fit into your NICU’s care strategies. It can also empower your team to integrate transcutaneous monitoring into unit protocols, or broaden its application in your facility, ensuring you fully leverage its benefits for your patients.
Reducing Iatrogenic Blood loss
In the NICU, regular blood gas sampling is a standard practice, particularly for patients with conditions like respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD). This frequent testing helps clinicians closely monitor key parameters, notably PCO2, which provides insight into the adequacy of respiratory support strategies. Keeping a close eye on PCO2 is important because it can change quickly in these patients. PCO2 values that are too high (hypercarbia) or too low (hypocarbia), as well as fluctuations or sharp changes, can put them at risk for damage to the brain, including intraventricular hemorrhage (IVH). ¹
Such frequent laboratory testing can cause significant blood loss for infants in the NICU. Research has shown that very low birth weight (VLBW) infants undergo an average of nearly 57 blood gas measurements per week,² and another found that up to 30% of a neonate’s circulating blood volume could be drawn for lab work each week during their first six weeks of life.³ While it is vital to keep a close eye on these patients, the blood loss from this frequent testing can pose serious risks, including anemia of prematurity and the potential need for blood transfusions.
By supplementing blood draws with transcutaneous readings, NICU teams can minimize the frequency of painful blood draws, without losing visibility to CO2. Transcutaneous CO2 monitoring’s continuous, noninvasive approach can help support informed care decisions with real-time and trending data.
Reducing Iatrogenic Blood loss
In the NICU, regular blood gas sampling is a standard practice, particularly for patients with conditions like respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD). This frequent testing helps clinicians closely monitor key parameters, notably PCO2, which provides insight into the adequacy of respiratory support strategies. Keeping a close eye on PCO2 is important because it can change quickly in these patients. PCO2 values that are too high (hypercarbia) or too low (hypocarbia), as well as fluctuations or sharp changes, can put them at risk for damage to the brain, including intraventricular hemorrhage (IVH). ¹
Such frequent laboratory testing can cause significant blood loss for infants in the NICU. Research has shown that very low birth weight (VLBW) infants undergo an average of nearly 57 blood gas measurements per week,² and another found that up to 30% of a neonate’s circulating blood volume could be drawn for lab work each week during their first six weeks of life.³ While it is vital to keep a close eye on these patients, the blood loss from this frequent testing can pose serious risks, including anemia of prematurity and the potential need for blood transfusions.
By supplementing blood draws with transcutaneous readings, NICU teams can minimize the frequency of painful blood draws, without losing visibility to CO2. Transcutaneous CO2 monitoring’s continuous, noninvasive approach can help support informed care decisions with real-time and trending data.
Reducing Iatrogenic Blood loss
In the NICU, regular blood gas sampling is a standard practice, particularly for patients with conditions like respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD). This frequent testing helps clinicians closely monitor key parameters, notably PCO2, which provides insight into the adequacy of respiratory support strategies. Keeping a close eye on PCO2 is important because it can change quickly in these patients. PCO2 values that are too high (hypercarbia) or too low (hypocarbia), as well as fluctuations or sharp changes, can put them at risk for damage to the brain, including intraventricular hemorrhage (IVH). ¹
Such frequent laboratory testing can cause significant blood loss for infants in the NICU. Research has shown that very low birth weight (VLBW) infants undergo an average of nearly 57 blood gas measurements per week,² and another found that up to 30% of a neonate’s circulating blood volume could be drawn for lab work each week during their first six weeks of life.³ While it is vital to keep a close eye on these patients, the blood loss from this frequent testing can pose serious risks, including anemia of prematurity and the potential need for blood transfusions.
By supplementing blood draws with transcutaneous readings, NICU teams can minimize the frequency of painful blood draws, without losing visibility to CO2. Transcutaneous CO2 monitoring’s continuous, noninvasive approach can help support informed care decisions with real-time and trending data.
Continuous Monitoring, Titration, and Weaning of Mechanical Ventilation Supports
During mechanical ventilation (MV), the continuous visibility of CO2 with transcutaneous monitoring can support NICU teams in keeping a close eye on a neonate’s ventilatory status. Continuous visibility enables a proactive approach to ongoing ventilation titration as well as detection of ventilatory issues. Monitoring a patient’s response to vent changes in real time can help caregivers make prompt adjustments and fine-tune settings.
Having continuous visibility of CO2 and the ability to make proactive adjustments is especially important during weaning. Given the vulnerability of premature infants to injuries from prolonged ventilator support, minimizing the duration of MV is a critical goal within the NICU. By providing real-time feedback on a neonate’s response to reduced ventilatory support, this technology enables clinicians to observe how each adjustment impacts gas exchange. This can help to instill confidence in the NICU team, as they can see that adequate gas exchange is maintained throughout the weaning process.
Continuous Monitoring, Titration, and Weaning of Mechanical Ventilation Supports
During mechanical ventilation (MV), the continuous visibility of CO2 with transcutaneous monitoring can support NICU teams in keeping a close eye on a neonate’s ventilatory status. Continuous visibility enables a proactive approach to ongoing ventilation titration as well as detection of ventilatory issues. Monitoring a patient’s response to vent changes in real time can help caregivers make prompt adjustments and fine-tune settings.
Having continuous visibility of CO2 and the ability to make proactive adjustments is especially important during weaning. Given the vulnerability of premature infants to injuries from prolonged ventilator support, minimizing the duration of MV is a critical goal within the NICU. By providing real-time feedback on a neonate’s response to reduced ventilatory support, this technology enables clinicians to observe how each adjustment impacts gas exchange. This can help to instill confidence in the NICU team, as they can see that adequate gas exchange is maintained throughout the weaning process.
Continuous Monitoring, Titration, and Weaning of Mechanical Ventilation Supports
During mechanical ventilation (MV), the continuous visibility of CO2 with transcutaneous monitoring can support NICU teams in keeping a close eye on a neonate’s ventilatory status. Continuous visibility enables a proactive approach to ongoing ventilation titration as well as detection of ventilatory issues. Monitoring a patient’s response to vent changes in real time can help caregivers make prompt adjustments and fine-tune settings.
Having continuous visibility of CO2 and the ability to make proactive adjustments is especially important during weaning. Given the vulnerability of premature infants to injuries from prolonged ventilator support, minimizing the duration of MV is a critical goal within the NICU. By providing real-time feedback on a neonate’s response to reduced ventilatory support, this technology enables clinicians to observe how each adjustment impacts gas exchange. This can help to instill confidence in the NICU team, as they can see that adequate gas exchange is maintained throughout the weaning process.
Continuous Monitoring for High-Frequency Ventilation (HFV)
High-frequency oscillatory ventilation (HFOV) and high-frequency jet ventilation (HFJV) are often used in situations where conventional mechanical ventilation can’t adequately maintain gas exchange, or when there is an increased risk of lung injury. HFOV, in particular, is highly effective at removing CO2, which can lead to rapid changes in CO2 levels once initiated. These rapid fluctuations can negatively impact cerebral blood flow, increasing the risk of brain injury in neonates. Therefore, it is crucial to closely monitor CO2 levels when using these ventilation strategies.
The American Association for Respiratory Care (AARC) recommends transcutaneous CO2 monitoring for neonates on these ventilation modalities, as it can allow NICU teams to detect hypoventilation or respiratory depression.4 This approach can allow clinicians to closely monitor and quickly adjust CO2 levels as needed to keep them within safe ranges and minimize the risk of complications.
Continuous Monitoring for High-Frequency Ventilation (HFV)
High-frequency oscillatory ventilation (HFOV) and high-frequency jet ventilation (HFJV) are often used in situations where conventional mechanical ventilation can’t adequately maintain gas exchange, or when there is an increased risk of lung injury. HFOV, in particular, is highly effective at removing CO2, which can lead to rapid changes in CO2 levels once initiated. These rapid fluctuations can negatively impact cerebral blood flow, increasing the risk of brain injury in neonates. Therefore, it is crucial to closely monitor CO2 levels when using these ventilation strategies.
The American Association for Respiratory Care (AARC) recommends transcutaneous CO2 monitoring for neonates on these ventilation modalities, as it can allow NICU teams to detect hypoventilation or respiratory depression.4 This approach can allow clinicians to closely monitor and quickly adjust CO2 levels as needed to keep them within safe ranges and minimize the risk of complications.
Continuous Monitoring for High-Frequency Ventilation (HFV)
High-frequency oscillatory ventilation (HFOV) and high-frequency jet ventilation (HFJV) are often used in situations where conventional mechanical ventilation can’t adequately maintain gas exchange, or when there is an increased risk of lung injury. HFOV, in particular, is highly effective at removing CO2, which can lead to rapid changes in CO2 levels once initiated. These rapid fluctuations can negatively impact cerebral blood flow, increasing the risk of brain injury in neonates. Therefore, it is crucial to closely monitor CO2 levels when using these ventilation strategies.
The American Association for Respiratory Care (AARC) recommends transcutaneous CO2 monitoring for neonates on these ventilation modalities, as it can allow NICU teams to detect hypoventilation or respiratory depression.4 This approach can allow clinicians to closely monitor and quickly adjust CO2 levels as needed to keep them within safe ranges and minimize the risk of complications.
Reducing Neonatal Pain & Stimulation
Every routine test and procedure adds another layer of stress to the already fragile world of NICU babies. For these tiny patients, a capillary heel stick or arterial puncture equates to a painful and distressing experience.
Beyond immediate discomfort, blood draws and other sources of pain in the NICU have consistently demonstrated adverse effects on long-term neurological and developmental outcomes. Research has shown that infants with a higher number of skin breaks as newborns display poorer mental development indices at both 8 and 18 months of age.5 Further studies reveal that these impacts on cognitive outcomes extend even into school age.6,7
These findings highlight the critical need for pain reduction strategies, which can help support these patients’ outcomes well beyond their days in the NICU. Transcutaneous CO2 monitoring can be a valuable tool in these strategies, as it allows NICU teams to reduce reliance on blood draws by providing continuous visibility of CO2 levels.
Reducing Neonatal Pain & Stimulation
Every routine test and procedure adds another layer of stress to the already fragile world of NICU babies. For these tiny patients, a capillary heel stick or arterial puncture equates to a painful and distressing experience.
Beyond immediate discomfort, blood draws and other sources of pain in the NICU have consistently demonstrated adverse effects on long-term neurological and developmental outcomes. Research has shown that infants with a higher number of skin breaks as newborns display poorer mental development indices at both 8 and 18 months of age.5 Further studies reveal that these impacts on cognitive outcomes extend even into school age.6,7
These findings highlight the critical need for pain reduction strategies, which can help support these patients’ outcomes well beyond their days in the NICU. Transcutaneous CO2 monitoring can be a valuable tool in these strategies, as it allows NICU teams to reduce reliance on blood draws by providing continuous visibility of CO2 levels.
Reducing Neonatal Pain & Stimulation
Every routine test and procedure adds another layer of stress to the already fragile world of NICU babies. For these tiny patients, a capillary heel stick or arterial puncture equates to a painful and distressing experience.
Beyond immediate discomfort, blood draws and other sources of pain in the NICU have consistently demonstrated adverse effects on long-term neurological and developmental outcomes. Research has shown that infants with a higher number of skin breaks as newborns display poorer mental development indices at both 8 and 18 months of age.5 Further studies reveal that these impacts on cognitive outcomes extend even into school age.6,7
These findings highlight the critical need for pain reduction strategies, which can help support these patients’ outcomes well beyond their days in the NICU. Transcutaneous CO2 monitoring can be a valuable tool in these strategies, as it allows NICU teams to reduce reliance on blood draws by providing continuous visibility of CO2 levels.
Is Transcutaneous Monitoring Implemented in Your NICU?
If your NICU uses transcutaneous monitoring, understanding its wide range of clinical applications can help your team optimize their use of this technology for the benefit of your patients. Our Clinical Pocket Guide on Transcutaneous CO2 Monitoring for Neonates is a valuable resource that can assist your team in integrating this technology into your protocols or enhancing its use to support patient care.
Let’s talk!
If you’re interested in talking more about how transcutaneous CO2 monitoring can make an impact in your NICU, or learning where its use can be optimized at your facility, reach out — we’d love to hear from you!
References:
- 1
Hochwald, O., et al. Continuous Noninvasive Carbon Dioxide Monitoring in Neonates: From Theory to Standard of Care. Pediatrics. 2019.
- 2
Alves-Dunkerson, J.A., et al. Cost analysis of a neonatal point-of-care monitor. Am J Clin Pathol. 2002.
- 3
Carroll, P.D., Widness, J.A. Nonpharmacological, blood conservation techniques for preventing neonatal anemia–effective and promising strategies for reducing transfusion. Semin Perinatol. 2012.
- 4
Restrepo, R.D., et al. AARC Clinical Practice Guideline: Transcutaneous Monitoring of Carbon Dioxide and Oxygen: 2012. Respir Care. 2012.
- 5
- 6
- 7
Chau, S.M.Y, et al. Hippocampus, Amygdala, and Thalamus Volumes in Very Preterm Children at 8 Years: Neonatal Pain and Genetic Variation. Front Behav Neorosci. 2019.
