Non invasive monitoring in mechanically ventilated pediatric patients

Abstract

Cardiopulmonary monitoring is a key component in the evaluation and management of critically ill patients. Clinicians typically rely on a combination of invasive and non-invasive monitoring to assess cardiac output and adequacy of ventilation. Recent technological advances have led to the introduction: of continuous non-invasive monitors that allow for data to be obtained at the bedside of critically ill patients. These advances help to identify hemodynamic changes and allow for interventions before complications occur. In this manuscript, we highlight several important methods of non-invasive cardiopulmonary monitoring, including capnography, transcutaneous monitoring, pulse oximetry, and near infrared spectroscopy.

Keywords::

• capnography
• critical care
• mechanical ventilation
• near-infrared spectroscopy
• neonate
• non-invasive monitoring
• oxygenation index
• PaO₂/fraction of inspired oxygen ratio
• patient safety
• pediatric
• pulse oximetry
• regional oxygen saturation
• tissue oxygenation
• transcutaneous
• V_D/V_T

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• A combination of invasive and noninvasive monitoring is necessary to assess and manage cardiac output and adequacy of ventilation in critically ill patients.

• Capnography can be used to confirm endotracheal tube placement, monitor the integrity of the ventilator circuit, monitor alveolar ventilation and optimize gas exchange, while reducing the need for frequent blood sampling. Areas for further study include the use of capnography during high frequency mechanical ventilation and the relationship between volumetric capnography and cardiac output.

• Transcutaneous carbon dioxide monitoring can provide a reliable measurement of partial pressure of carbon dioxide and assist in the management of critically ill patients.

• Pulse oximetry provides continuous monitoring of oxygenation and helps to detect, manage and prevent acute hypoxemia. Further studies are needed to assess the potential benefits of using S/F and OSI ratios for early recognition of patients at risk of acute lung injury/acute respiratory distress syndrome.

• Near infrared spectroscopy provides continuous and safe monitoring of both tissue oxygenation and perfusion. It may assist in detecting life-threatening conditions during routine patient care, but additional studies are needed to validate the use of near infrared spectroscopy in patients with necrotizing enterocolitis, sepsis and traumatic brain injury.

Notes