Transcutaneous Monitoring of Carbon Dioxide to Optimize Ventilator Weaning in At-Risk Adults After Cardiopulmonary Bypass

Abstract

Background: Cardiopulmonary bypass use during surgery disrupts microcirculation, which can contribute to lung injury, particularly in patients with pulmonary comorbidities. Continuous transcutaneous carbon dioxide (CO2) monitoring assists clinicians to trend values related to metabolic and respiratory status between intermittent arterial blood gas measurements. We sought to review the literature to support adoption of this technology to optimize weaning in patients with pulmonary comorbidities following open heart surgery.

Methods: Multiple databases were reviewed. Inclusion criteria were limited to results of peer-reviewed articles in English published within the past 5 years. The findings were presented to relevant levels of hospital leadership, who approved adoption of the technology for this population. From there, monitors were positioned in 4 surgical intensive care unit rooms for monitoring of patients up to the point of extubation.

Results: The literature review yielded 12 articles, with a majority deeming transcutaneous monitoring feasible and appropriate in the postoperative patient, including those having cardiopulmonary bypass. Clinical interventions and trending were valuable additions to improve patient outcomes and nursing autonomy. During the fiscal quarter following adoption of the technology, mean time spent on the ventilator dropped 30%, reintubation dropped 4%, and mortality decreased by 24%.

Conclusions: Transcutaneous monitoring of CO2, with improved specificity over end-tidal CO2 monitoring, offers meaningful trending to inform clinician decision-making around readiness to wean. Additionally, transcutaneous monitoring allows for noninvasive, reliable continuous metabolic monitoring to serve as an early clinical indicator for at-risk patients.

Keywords: adult; blood gas; critical care; pulmonary comorbidities; transcutaneous carbon dioxide monitoring.