TCM4/40
Monitoring methods
Monitoring oxygen and carbon dioxide
There are several methods of monitoring oxygen and carbon dioxide in neonates and infants. These include:
- Transcutaneous monitoring of pO2/pCO2
- End tidal CO2 monitoring
- Pulse oximetry
- Blood samples
Each method poses certain advantages – and limitations. Transcutaneous monitoring offers an effective, non-invasive and continuous monitoring of pO2 and pCO2.
For optimal results, a combination of methods is typically recommended.
This case provides essential combined monitoring information on the oxygen delivery and the circulatory status.
Case: Combining monitoring methods
A term boy with birth asphyxia and meconium aspiration syndrome requiring HFO and surfactant instillation. At age 35 hours, with an FO2(I) of 0.45, a mean arterial blood pressure of 45 mmHg (6.0 kPa), and an infusion of dopamine of 6 mg/kg/min, tcpO2 started decreasing from 52 mmHg (6.9 kPa) to 44 mmHg (5.9 kPa) within less than an hour. All other parameters including blood pressure, pulse oximeter readings, and tcpCO2 were stable.
When tcpO2 decreased with stable pulse oximeter saturation, it was most likely caused by peripheral vasoconstriction. The stable arterial oxygen status and normal lactate concentrations were confirmed by a blood sample. A bolus of saline was administered, leading to an increase in tcpO2.
One hour later, tcpO2 started to decrease again without changes in other values. An echocardiography revealed poor contractibility of the heart, and infusion of dobutamine was initiated, leading to rapid normalization of tcpO2.
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