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Inquiry about capnography and capnography plus NIRS use in NICU


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Dear colleagues

There is an idea to investigate deeply correlation between EtCO2 and NIRS data and probably to develop some device for extracting, coupling and analysing these data.

That's why I am kindly asking you, dear colleagues:

1.    Please share your experience about how often do you use capnography in intubated and non-intubated infant at NICU. Is it like a standard for intubated infants?

2. What EtCO2 measurement device provides you with more accurate measurements vs PaCO2?

3. Do you use capnography and NIRS simultaneously in most severely ill infants? Do you also consider EtCO2 data in this case when you are estimating brain perfusion?

Many thanks!

Andrej Vitushka, MD, PhD, Minsk, Belarus.

 

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@Andrej Vitushka, @Vicky Payne, Hi, we don't have NIRS, but there is clearly a growing interest in it's validity and use in HIE & TH (neurodevelopmental prognostication) and end organ perfusion in the face of a HsPDA. One of our Consultants is keen to examine it's use on the Unit. We have gone full circle and use Transcutaneous monitoring on most of our babies, including Transport, it had gone out of favour (for no valid reason) in the face of EtCO2 capnography. I am sure the circle will turn again🙄.

Kind regards Alistair

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On 6/7/2021 at 4:09 PM, Vicky Payne said:

Thanks @Andrej Vitushka! At our NICU, EtCO2 is not used routinely on all babies- we use it on a case-by-case basis, and during surgery/transport. We do not use NIRS yet. Other UK NICUs may have a different experience and may use it more frequently.... @ali?

Many thanks @Vicky Payne and @ali Great to know this. Vicky how do you monitor CO2 mostly - by transcutaneous device as Alistair et al. do or by taking blood gases? @ali how are you satisfied with trascutaneous monitoring in unstable VLBW infants in terms of accuracy and complications (burns first of all)?  

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We mostly take blood gases, but if using other methods it tends to be capnography. We have trialled some transcutaneous CO2 recently that appeared to be quite good for monitoring trends without the skin burns that were seen in the past. Personally I think alternative methods like capnography or tcm for measuring CO2 are underutilised, and would be useful for monitoring trends.

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Dear Andrej,

We run a third level NICU without surgery. So our main focus is on premature babies and we are really focused on “minimal invasive”. On our ward we use continuous Co2-monitoring ventilated patiënts. We don’t use CO2 measurements in not intubated patiënts. 

In (our) ideal situation Tc and eT are parallel monitored because both are effected differently by patiënt conditions (eg skin perfusion, lung perfusion, …) and we really want to get trends were we can trust. So I think there is not one technology preferent or delivers more accuracy because the patient conditions are relevant. We only take extra bloedsamples if the measurements are not consistent or for other reasons.

As technology we use the Tc sensor from Philips/radiometer and for eT we use Mainstream (Philips/respironics) and sidestream (Oridion) technology. Because of sensorweight and deadspace Mainstream is used in (near)term patients  (>2500gr) and sidestream in premature pat. (From 500gr). Tc is used for all patiënts behalve extreme premature (<26 wk.) - there we first look for skin condition and decide individually what is best (risk for skin leasions vs. Hypocapnia).

In severe ill patiënts (in our situation mostly sepsis, MAS, PPHN, HIE with hypothermia) we standard use aEEG, NIRS and ventilatory monitoring (Tc of eT-CO) in all patiënts. From clinical perspective we use CO2 monitoring primary to prevent extreme situations causing problems  (eg hypercapnia in PPHN, hypocapnia in HIE).

Hope this gives you a bit more ideas 🙂

 

Kind regards,

Thilo

 

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