Transcutaneous carbon dioxide monitoring in infants and children.

OBJECTIVE To review the technology required for and the applications of transcutaneous carbon dioxide (TC-CO2) monitoring in infants and children. DATA SOURCE A computerized, bibliographic search regarding the applications of transcutaneous carbon dioxide (TC-CO2) monitoring in infants and children. RESULTS Although the direct measurement of P(a)CO2 remains the gold standard, it provides only a single measurement of what is often a rapidly changing and evolving clinical picture. Given these concerns, there remains a clinical need for a means to continuously monitor P(a)CO2 without the need for repeated blood gas analysis. Although initially introduced into the neonatal intensive care unit; with improvements in the technology, TC-CO2 monitoring can now be used in infants, children and even adults. When compared with end-tidal carbon dioxide (ET-CO2) monitoring techniques, TC-CO2 monitoring has been shown to be equally as accurate in patients with normal respiratory function and more accurate in patients with shunt or ventilation-perfusion inequalities. TC-CO2 monitoring can be applied in situations that generally preclude ET-CO2 monitoring such as high frequency ventilation, apnea testing, and noninvasive ventilation. TC-CO2 monitoring has also been used in spontaneously breathing children with airway and respiratory issues such as croup and status asthmaticus as well as to monitor metabolic status during treatment of acidosis related to diabetic ketoacidosis. CONCLUSIONS Transcutaneous carbon dioxide monitoring may be a useful adjunct in various clinical scenarios in infants and children. It should be viewed as a complimentary technology and may be used in combination with ET-CO2 monitoring.

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